Rainscombe House

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Although we were told improvements had been made to people’s care to help ensure they were shown the respect and dignity they deserved, we did not find this was consistent. There was a closed culture at this service. People did not experience a culture of kindness and respect where their wishes were listened to and acted upon. People had little or no control over their lives: staff made minimal effort to communicate with or involve people, and made decisions for them. People’s emotional well being was not prioritised: staff and leaders did not demonstrate compassionate care which centred around each individual. The registered provider had failed to ensure people lived in a homely environment that was well maintained and suitable for its purpose. Staff did not respect people’s home as they came and went throughout our first day of assessment, often without staff acknowledging people. Staff did not always support people’s independence. This was a continued breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service scored 30 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

While the relatives we spoke to expressed they were generally happy with their loved one’s care, our assessment found care did not meet the expected standards: there was a closed culture at this service. People did not experience a culture of kindness and respect where their wishes were listened to and acted upon. People had little or no control over their lives: staff made little effort to communicate with them, and made decisions for them. People’s emotional well being was not prioritised: staff and leaders did not demonstrate compassionate care which centred around each individual.

Staff and leaders continued to lack insight into how their actions and behaviours had a detrimental impact on people’s lives. We asked the registered manager how they felt things had improved in relation to the way staff behaved towards people because at previous visits we had observed a lack of interaction as well as a lack of respect shown towards people. They told us, “All staff re-trained. I set quizzes and on the spot questions to gauge their understanding of the training and easy-read slides as reminders.” Leaders and staff were unable to demonstrate any significant improvements to how they ensured people were always treated with kindness, compassion and dignity: staff told us they involved people in decisions, but we found this was not the case: people’s preferences and wishes were not sought or acted upon. For example, during this assessment staff said people were going to the pub later in the day. We were told, “We will ask them if they want to eat here first or eat at the pub.” We did not hear this happen. Instead staff decided people would go to a party next door without asking people if that was what they would prefer to do.

Following a visit to the service carried out by professionals, they reported to us, “[Staff member] was sat on the sofa next to resident with his arms folded (not displaying open body language). He wasn’t engaging with the resident.” They also noted that some people’s food sat out for a long period of time because there were not enough chairs for staff to sit beside people to support them with their lunch. One person’s lunch in particular would have been cold by the time they had it as it had sat out for 30 minutes.

We continued to observe a lack of kindness, compassion and dignity: at previous assessments, staff were not always treating people with respect and dignity, at this assessment, little had changed. Staff did not treat the service as the home of people living there. On our first day 6 different staff came in and out of the service over and above the 2 staff on duty. Most did not acknowledge people, but came in to deliver keys, check something with staff or to collect something. On our second day, the night staff member had left their overnight bag and mobile phone on charge on people’s lounge chair. We observed that despite people’s records showing what their preferences and wishes were, these were not considered. Since our last visit, a new dining area had been added to the home, however, little care had been given to ensuring it met people’s needs: we found the table was very wobbly. The registered manager told us, “I have raised it many times” and a senior manager said the table would be fixed the same day but it was not. However, it was replaced following our assessment. There continued to be an institutional feel to the service, and despite it being people’s home, we saw the medicines cabinet was installed on the wall in the lounge and there was a cabinet in the dining room used to store staff files. A noticeboard for staff was on the wall in the kitchen. Despite the new room only being finished in January, there was a small area of exposed plaster, chipped paintwork and untidy edges on the windowsill. The paintwork had not been finished off properly around the opening into the lounge and the patio door blind was hanging down. One person’s bedroom had large brown stains on their ceiling and the cornice and the tap on their basin was lose. Staff did take time to engage with people, but again this was not consistent. One staff member asked people if they would like to play a game, but another staff member sat beside one person not engaging with them.

People experienced an inconsistent approach towards being treated as an individual. Whilst some people had improved experiences as they had started to go to activities of their preference, this was not reflected in people’s overall experience of living at the service: people were not always supported with their health needs or their social needs. Leaders and staff continued to ignore professional guidance and people’s wishes, this led to poor and inconsistent outcomes for people, as the culture was not empowering or centred around people’s individual skills, strengths and personal goals.

The registered manager told us, “I have tried so hard to get staff not to take everyone out together. It is tiny steps and we are wracking our brains to think of different things to meet people’s individual needs.” Despite this feedback from the registered manager we did not always find this was happening.

Whilst we observed that some staff attempted to encourage people to make choices around what they wanted to do, we also observed a continued culture from staff of making decisions on people’s behalf without consulting with individual’s, or having any regard to people’s known preferences, including clear preferences about what caused people stress and anxiety. For example, during our assessment everyone went to a party, without consultation. This is despite one person’s records clearly stating that parties caused them anxiety. People had care plans which recorded their preferences. One person’s care plan said, ‘I tend to eat most of my meals in the dining room with the other residents. If the day is sunny staff should offer me to have my meal in the garden’. Despite the sunny weather on the first day of the assessment, we did not hear staff offer this.

Process to ensure people were treated as individuals, with their needs and preferences met were inadequate. Despite an improvement in people's records about their wishes and preferences, these were not adhered to. For example, one person’s care plan recorded their family had a strong faith and they used to attend church with them and yet, there was no evidence that this had been followed up by staff to support this person to practice their faith. A second person liked to ‘access the community’ every day, but from the daily records in July, there were 8 days when they did not go out. Other people had clear records which stated activities and circumstances which caused them heightened anxiety, yet this was ignored, and people participated in activities which staff and leaders knew would be detrimental to them. Leaders failed to recognise this, or provide suitable guidance to staff when it was clear that people's preferences had been ignored.

Some people were being supported better to improve their independence and choice and yet this was not consistent. We heard from a relative that they felt their family member’s choices were respected, “To an extent.”

Staff said more daily skills were being introduced to people. We were told, “[Person’s name] is encouraged more in household chores and will help with meal preparation.” We read this in daily records for people, however, we still observed people being encouraged to sit back down when they tried to access the kitchen area.

Our observations were that at times people were encouraged to do things for themselves and make their own decisions but this was not consistent. One person was asked if they wished to help make the lunch and they did participate to an extent and yet another person who was able to help make their tea was encouraged by a staff member to sit back down when they tried to move towards the kettle.

Processes to ensure people were supported with independence, and had choice and control over their lives were inadequate. Leaders had failed to drive improvement, the impact of this was people were not in control of their lives, and remained reliant on staff and leaders who did not respect their choices or treat them as individuals. People were not consistently given choice or control. People went out or participated in activities together. On 15 occasions in July people took part in the same outing or the same activity within the home and we noted people went on long drives together with no evidence of people being given a choice of what they wanted to do or where they wanted to go. A professional told us when they visited people were having a roast dinner with mashed potatoes. When asking staff why people did not have roast potatoes they were told people did not like roast potatoes. However, we read in people’s daily notes that they regularly had roast potatoes with a roast dinner.

We did not look at Responding to people’s immediate needs during this assessment. The score for this quality statement is based on the previous rating for Caring.

We did not look at Workforce wellbeing and enablement during this assessment. The score for this quality statement is based on the previous rating for Caring.