Archived: Rainscombe Bungalow

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 1 relative told us staff were kind towards their loved one, people were at risk of receiving institutionalised practices. People received varied outcomes around choice and control of their care. This seemed particularly poor for people with a learning disability. This meant the service was not meeting the principles of RSRCRC as the model of care did not maximise people's choice, control and independence and the care was not person-centred. We found concerns around people not always being treated in a caring, respectful and dignified way.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a mixed response from relative’s and advocates on whether staff were always kind and attentive. One told us, “Some good ones (staff), 1 is really engaging but some (staff) feel very awkward.” Whilst people did not raise concerns with us directly, other evidence showed people had not always been treated in a caring and dignified way.

Staff gave limited feedback on how they would provide compassionate and dignified care for people. Their responses included, “They (people) are used to us” and “Staff know people well.”

External professionals told us staff did not always treat people with dignity and respect. One fed back staff were not always considering the lack of dignity of how staff were describing people in front of them. Another professional told us, “They (staff) were quite patronising to people and were asking them to say hello to me. It was like they were talking to children.”

One member of staff came into the home from the home next door and did not acknowledge any people. They just walked past people into the office and back into the kitchen to make a note in the communication book. When staff were supporting people to have their meal there was very little interactions or impromptu conversations with them. One member of staff went and sat in the lounge opposite 1 person and started to update people’s care record on their electronic tablet. The person tried to interact with the member of staff but was ignored. The person then got up and left the room. On day 2 a member of staff approached the dining table and interrupted people’s meals to give them medicine. The member of staff confirmed none of these medicines were required to take with food. One person had to wait over 20 minutes for their dinner and only started once everyone else had finished. There was undignified language used in people’s medicine care plans including, “(Medicine) used for temper tantrums” and “Praise X when displaying appropriate behaviour.” On day 2 a member of staff walked into a bathroom without knocking whilst a person was having a shower. We were walking past the bathroom and saw the person in the shower. We did see some examples of kind actions by staff. Party food, decorations and cake were provided to people when it was their birthday.

There was mixed feedback from relatives and advocates that staff really knew and understood the people they were supporting. People were not always treated as individuals and were not always being supported with their needs and preferences.

Staff were not able to tell us about who people were as individuals. The feedback we received was more around the care tasks they needed to provide to people.

We observed numerous instances of people being ignored, and of people’s individual needs and wishes not being considered. Although we observed staff were often with people, there were no meaningful interactions. For example, we observed people were not acknowledged by staff or responded to when people spoke to them. We heard 1 person ask a member of staff for a cup of tea, but this was ignored by the member of staff. When a member of staff came from the service next door, they did not say hello to people but walked into the office and then back into the kitchen without any acknowledgement of people that lived there. Although we observed staff offering indoor activities to people, these were not individualised to people’s preferences and wishes

The care notes we reviewed were often a copy and paste from previous days. This duplicated information made it difficult for the provider to ensure people were being treated as individuals that may have different reactions to care each day. There were frequent references to people being ‘content’ without any detail on what this meant.

People were not always given choices around their care and instead care was delivered as part of a system and culture of institutionalised practices. For example, people were routinely showered twice a day. It was not clear from people’s initial assessments this was down to their preferences but more around this practice being embedded by staff over a period of time. People would then see this as the norm for their daily routine as opposed to making their own choices.

Staff told us they gave people choices around their care however what staff recorded around choices did not reflect what we observed at the assessment. For example, we saw staff recorded in care notes people had been offered choices of what they wanted for their lunch and dinner, however we did not observe these choices being offered. The registered manager told us, “It is really hard to change a house which has been established like it has.”

People were not always supported with their independence. TThe door in the lounge that led to the back of the house had been locked due to 1 person pushing the door open in an unsafe way. Rather than considering replacing the door with one that was unable to crash open, all people who wanted, were unable to access the garden without staff having to take them around the front of the house. We did observe 1 person independently cleaning up in the kitchen after people had eaten. Records showed this person liked to assist staff to clean their bedroom and undertake daily chores.

There were embedded practices in the home that were more to fit around the staff routine rather than people’s preferences. We saw from care notes people were going to bed and waking up at the same time every day. The records showed that over a 3-month period the same 4 people were showered and dressed by night staff before they went off duty. This was also the same for people going to bed at night, most people were showered and went to bed before night staff came on duty.

People were not always supported by staff with their immediate needs. Staff were not always able to recognise when people needed emotional support.

We asked 1 member of staff how they would support a person when they become anxious. They told us “I just play with X clapping X hands.” There was no consideration that the person may require some support to determine why they were anxious. The registered manager told us 1 one became very anxious prior to any health appointments, and we saw this from their care records. However, there was no care plan in place with guidance for staff on how best to prepare the person for these appointments.

Staff were not always responding to people’s need for emotional support or comfort. We saw from the care notes, 1 person was anxious and crying through the night. This was recorded every hour. There was no record of any support of comfort provided to the person. We saw another person continuously wanting to take their helmet off as they did not like wearing it. There was no record in their care plan the helmet was required all the time they were in their wheelchair and staff were not being proactive in establishing if this was needed. Instead, staff would just put the helmet back on.

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.