Rainscombe House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

People were still not receiving care and support in line with Right Support, Right Care, Right Culture guidance. Activities were not always individualised or meaningful to people. People continued to go out as a group on the majority of occasions and staff spent a lot of time taking people on long drives which appeared to have no purpose. People had key workers and yet there was no evidence that this system benefitted people at all. People’s daily notes were not always a truthful reflection of what had occurred during a person’s day. Some pictorial information was being provided, but the registered manager had not considered other ways to robustly ensure people felt supported in the running of their home. This was a continued breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not receive person centred care. Although records relating to people's assessed needs, wishes and preferences had improved, they were not a true reflection of people's experiences. People's care was not centred around them and their needs: staff and leaders did not work collaboratively with partners to ensure people's care was coordinated. Regular long drives ‘in the community’ occurred, some for 3-hours. There was no record of people stopping, having a drink or food, or being able to use the toilet. There was no destination or purpose for these drives and care plans did not specifically record people liked doing this. People accessed the sensory room in Rainscombe Bungalow, although everyone went at the same time. The room was only large enough for one person which meant people may have to wait to use the room reducing their enjoyment and the benefit of it. Despite the importance for one person to go to a day centre, the registered manager said their name had only been added on the waiting list 2 months ago. There was little evidence to show a person funded for 30 hours 1:1 staffing received this.

Staff were not always aware of specific guidance in place for people. One staff member told us in relation to one person’s digestive monitoring, “If she hasn’t opened her bowels for 4 days, then we give PRN (as required) medication.” However, this person’s care plan stated the medication should be given after 3 days. People had key workers, but there was no evidence of how this improved people’s lives or the care they received. Key workers did not meet with people to record goals or achievements. Professionals told us, “I find staff don’t seem confident in talking to professionals particularly concerning when they are the person’s key worker. They just direct all your questions to the shift leader.”

We observed that experiences and activities were still not individualised or tailored to people’s wishes and aspirations. Daily notes recorded more frequent activities on offer to people, but we could not be sure notes were a true record. Daily notes for our first day recorded one person had been in the garden and people had been offered lunch choices in line with the menu. Neither of these happened. People were offered sandwiches when the menu planner showed beans on toast. One person was noted as responding ‘positively’ to lunch, but we heard them consistently saying ‘no’ when offered it. A second person was noted as setting the table, which they did not do. Staff also recorded a person ‘clapped’ during a game, but this person had declined to participate. The second day staff said two people were offered breakfast choices, one set the table and another person ate their breakfast. This did not happen. People were not given breakfast choices, the staff member set the table and the person who staff recorded had eaten their breakfast ate nothing and only had a cup of tea.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

People were not always provided with information in a way that was suitable for them. Although people’s menu planner and activity schedule was in pictorial format other information was typed. A relative told us, “I have seen them use pictures when they (staff) are talking about what she wants to eat.”

Staff said they used different forms of communication with people. One staff member said, “I’ve done Makaton (a form of sign language) and [person’s name] uses Makaton.” However, although we saw the person use some simple signs with staff, we did not see staff respond to the person using Makaton.

Some pictorial information was available to people, for example, the menu planner and their activity schedule, although we saw the menu planner was stored in a folder in the staff cabinet which was not accessible to people. However, there was still a large amount of documentation which was typed. For example, there was a board in the kitchen area which had safeguarding information and information for staff, but nothing pictorial for people. Although the format of residents meetings had changed and the minutes were recorded in a semi-pictorial format, staff had still not developed a really effective way to gain feedback from people as people were in the main, non-verbal. The minutes used statements like, ‘as per schedule’ (for cleaning), ‘checked and tallied’ (for medicines) and ‘maintained on excel spreadsheet’ (for monies). None of these statements would mean anything to people.

We did not look at Listening to and involving people during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Equity in access during this assessment. The score for this quality statement is based on the previous rating for Responsive.

People did not always have the opportunity to experience activities of their preferred choice as there continued to be a theme of people all going out together.

Staff gave differing feedback on what people were doing during our first day of inspection. One staff member told us, “They are all going to the pub at about 5:30.” This same staff member confirmed this early afternoon telling us, “We will ask them if they want to eat here first or they want to eat at the pub.” However, approximately half an hour later a second staff member told us, “They are going to [person’s name] party next door at 4:30, they are not going to the pub.” We left the service at 16:45 and saw people were just being supported to have a shower. The daily notes we reviewed the following day indicated they had gone to the party at around 6pm. Staff had not asked people if they wished to go to the party instead of the pub and one person in particular did not like parties as it increased their anxiety. Despite people’s activity planner recording their weekly schedule, people were not always supported to follow this. One person’s activity planner said they should have gone to the YMCA on the morning of our first day of assessment, but we had not seen them leave the service. We asked the senior staff member who appeared confused, but then told us the person had refused. Yet, there was no indication they were offered this outing and there was nothing recorded in their daily notes. We later spoke with the registered manager who told us this person went to the YMCA on a Monday. They were surprised to hear that they had not attended and were unable to tell us why. However, there had been some small improvements in that one person who liked the cinema was now being supported to go and see films and another person who liked gardening had helped to purchase new plants for the back garden.

There were insufficient processes or systems in place to ensure that people were given equal opportunities to access the community on an individualised basis participating in activities of their choice. Even though the registered manager audited activities, they had failed to identify that people were still regularly going out together.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.