Rutland House Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Managers made sure people, relatives and staff could report safety concerns and events, in confidence, at any time. The nominated individual (who is responsible for supervising the management of the service on behalf of the provider) told us, “I am constantly reiterating with staff to tell me if they see something that isn’t right. It’s a small place and I encourage the staff to talk to me…people and relatives have my phone number and they can call me or email me at any time.”

Systems were in place to help staff report and record safety concerns and events when these arose. A staff member told us, “I would tell the person in charge and record everything.” Safety concerns and events were investigated by managers and the learning from these was used to support the service to learn and improve safety for people at the service.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Information was obtained from people about their individual needs and risks to their safety. This was used to develop person centred care and risk management plans to make sure people received safe and appropriate care and support as soon as they started to use the service. The nominated individual told us, “We do the pre-assessment and we get the social services report. I will review this and raise any concerns if needed. We review people’s needs and make sure we have the skills to meet these. We also look to see if people can be looked after safely. We also check if people will fit in to the existing community here. We do have beds available but we won’t fill them for the sake of it. People have to be able to fit in and that is part of this, as it's a calm environment.” A healthcare professional said managers made timely referrals to their service to make sure people received support for all their clinical needs as soon as they started using the service.

Partners told us the service worked well with them to make sure arrangements in place to care and support for people were safe. A healthcare professional said, “The home help me in my role by keeping accurate and up to date monitoring records as requested.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The provider had made improvements since our last inspection and was no longer in breach of regulations. The service was now working within the principles of the Mental Capacity Act (MCA). Appropriate legal authorisations had been obtained to deprive people of their liberty, where this was deemed necessary to ensure their safety. Systems were in place to ensure mental capacity assessments were completed with people and others involved in their care. Where people could not make decisions and consent to their care, processes were in place to make sure any decisions would be made in their best interests.

People told us they were safe at the service. One person said, “If I didn’t feel safe I would say so to any staff.” Another person told us they would talk to the managers if they didn’t feel safe. A relative said, “There is never a raised voice here and the atmosphere is warm and friendly.” A healthcare professional told us, “Residents appear to be relaxed and contented during my visits, have opportunities for meaningful engagement with each other and with care staff…no rigid rules are imposed on residents.”

We observed people were comfortable and at ease with each other and with the staff team at the service. Staff knew people well and remained alert to any changes that might indicate people needed reassurance to reduce any anxiety or discomfort they might be experiencing.

Staff and managers understood how to safeguard people and systems were in place to help them make timely referrals to the relevant persons and agencies. Managers worked proactively with the relevant agencies, when a concern was raised, and took appropriate action to safeguard people from further risk, when this was required.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The provider had made improvements since our last inspection and was no longer in breach of regulations. People’s records now contained up to date information for staff about identified risks to people’s safety with guidance on how these should be managed, to keep people safe from harm. Systems were in place to ensure risks to people were continually assessed, monitored and reviewed. A staff member told us, “We have the care records and procedures that tell us what we need to do, to keep people safe. Every month the care plan and risk assessment is updated. We always make sure there are no hazards and emergency exits are clear. If people are using frames we are observant. We are always observing people to make sure they are safe.”

People were supported to stay safe at the service whilst continuing to do the things that mattered to them. One person told us, “I can walk about by myself and my room is upstairs. The carers are always there to see that we are alright.” Another person said, “I can walk but like to have help because I sometimes feel a bit muzzy.” A relative told us, “Providing [family member] has help, as she needs a wheelchair, she can do anything within reason.” A healthcare professional said, “The staff appear to understand the balance needed between managing safety and therapeutic risk taking. I have never observed staff telling a resident to ‘sit down’ to manage falls risk, instead staff support residents to mobilise safely with discreet supervision, not asking residents why they continue to need to move about the home in the context of their dementia.”

We observed people moved freely around and spent their time as they wished, with no unnecessary restrictions. Staff were aware of where people were and remained present and available in case people required their assistance.

The provider did not always detect and control potential risks in the care environment.

We observed during our site visit, carpet mats had been placed on steps leading out to the back garden. This was a potential trip hazard. We were assured people were not currently at risk because staff were present and supporting people to move safely around the environment. However, this remained a potential trip hazard. We discussed this with the nominated individual who took immediate action to have these removed to reduce any potential risk to people. They contacted us after our site visit to tell us they had had taken additional steps to remind all staff of the importance of maintaining an environment clear of slip and trip hazards. They had also arranged for all staff to attend refresher training in health and safety refresher training.

Other aspects of the environment were safe. People told us the home was a safe and comfortable place to live. One person told us, “It is really homey here and always warm. Sometimes too much!” Another person said, “I love it here. Just like home with family.” A relative told us, “Extremely comfortable. A real feeling of family!”

Notwithstanding the issue with the mats, staff understood the need to maintain a safe environment for people. One staff member told us, “Every day I check the home and make sure there are no hazards and then we start our day.” The provider made sure safety systems and equipment were maintained and serviced at regular intervals. This helped to ensure the environment, and equipment used, remained in good order and safe for use.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People said there were enough staff to meet their needs. A relative told us, “Mum has had fantastic care, so I think so.” Another relative said, “Surprisingly in today’s world, yes.”

Staff told us they worked well together and had enough time to complete their duties and provide people with the care and support they needed. Managers made sure staffing rotas were planned based on people’s dependency and individual needs.

Staff were provided with regular and relevant training to meet people’s needs. They were supported through a regular programme of supervision to continually learn and develop in their roles. One person told us, “They (staff) know their job.” A staff member said, “We have regular training. We get reminded to refresh this. And we get supervision. They are helpful meetings. We get to learn and know more about people especially if there are any changes. There is good sharing of information about people here.”

The provider had made improvements since our last inspection and now made sure they operated safe recruitment practices to ensure only suitable staff were employed to work at the service.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People were supported to live in a clean, hygienic environment. One person said, “It is always clean.” Another person said, “It is just a home from home and very clean.”

Staff received relevant training and knew the processes to follow to minimise the risk and spread of infection. Staff had access to resources and equipment to help them reduce infection risks. Managers undertook regular checks on staff’s practice. The nominated individual told us, “We do spot checks on staff on hand washing and wearing the correct personal protective equipment (PPE). We haven’t had any issues around staff practices of using PPE.”

Staff maintained cleaning and food safety records to provide a clear audit trail of measures taken to reduce infection risks. The provider’s infection prevention and control policy was current and reflected national guidance.

The provider always made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Managers worked proactively with the relevant healthcare professionals to ensure people received medicines that met their needs. They raised concerns and challenged, in an appropriate way, instances when people may have been prescribed medicines that were negatively impacting on their health and wellbeing. The nominated individual told us they had recently, through working with healthcare professionals, had the medicines of one person reviewed and changed which had led to a reduction in recurring infections the person had been experiencing. A healthcare professional said, “The managers of the home act quickly when advocating for the residents, seeking support of the GP and external agencies if a resident appears to be being prescribed sedative medications with unclear clinical indication.”

People received their medicines safely and as prescribed. One person told us, “They (staff) come at the same time every day and if I need something extra it is given to me.” Another person said, “If I have a headache they bring me a drink or a pill.”

Medicines stocks, balances and records showed people consistently received the medicines prescribed to them. The provider had made improvements since our last inspection and now made sure guidance about people’s ‘as required’ medicines (PRN) was reviewed and updated at regular intervals.

Staff received relevant training and were clear about their roles and responsibilities in relation to the safe management and administration of medicines. There were regular audits of medicines and checks on staff’s practice.