It was clear from all the information and intelligence we gathered about the provider during the review process that the care the people who live at Rafael Home receive meets the essential standards of quality and safety, which is being delivered in a way that respects their dignity and protects their rights.All the feedback we received from the people who use the service was extremely complimentary about the standard of the care and support they received at Rafael Home. One person summed up the views of people who use the service when they told us, "I've lived here a long time and want to stay' and 'I like my bedroom and the staff'.
The people who use the service told us staff help them make their own choices about what they do everyday. People who live at Rafael Home told us, 'I choose my own clothes', 'I get up and go to bed when I want', 'staff always ask me what I want for dinner', and 'I chose the colour my bedroom was painted'.
It was clear from practices we observed that staff are good at enabling the people who use the service to do at much for themselves as they are willing and capable of doing so safely. One person summed up the views of the people who live at Rafael Home by saying, 'I help staff get my medicines out', 'I don't go out by myself, but one person who lives here does all the time', 'I polish my room, change my bed, and sometimes put my clothes in the washing machine', and 'we've all got keys to our bedrooms'.
It was also evident from comments made people who use the service that anyone that's willing to work is actively encouraged and supported by staff to do so. One person who lives at Rafael Home told us, 'I sometimes go to work in an office where I answer the phone' I get paid to go'.
People who live at Rafael Home told us their home was always kept clean and tidy. One person summed up the views of people who live there by saying, "the house always smells fresh', 'staff help me vacuum my bedroom sometimes', and 'there's always toilet tissue in the house'.
People who live at Rafael Home were very positive about the proprietor and the other staff that worked there. Typical feedback included, 'there's usually one staff here in the day and someone sleeps with us at night 'that's enough', 'staff treat us well, they are good to us', and 'Christine (i.e. the proprietor) looks after me' she's my friend'.
The proprietor and other staff we met during this visit were always observed interacting with the people who live at Rafael Home in a very kind, respectful, and professional manner.
The interior of Rafael Home is furnished and decorated to a good standard and has a very 'homely' and comfortable feel to it. The atmosphere within the service remained extremely relaxed, friendly, and congenial throughout the course of the visit.
What the service has improved since the last review:
The proprietor was able to provide us with evidence to demonstrate all the good practice recommendations identified in the services last review have been implemented. This included: the stream lining of care plans to make them easier for staff to use and find information when they needed it; and, ensuring people who use the service had the chance to go on holiday every year.
The proprietor told us the training staff now received was the single most significant improvement the service had made in the past year. Staff we met confirmed that in addition to their mandatory training they received when the first started working at Rafael Home they had recently attended courses in understanding the Mental Capacity Act, person centred care planning, sensory awareness, and working with people with epilepsy.
What they could do better:
All the positive comments made above notwithstanding we have made a number of suggestions where the service could improve its practice and continue meeting all the essential standards of quality and safety:
Risk management plans that are currently in place to help staff prevent and/or deal appropriately with behaviours that challenge the service do not always accurately reflect the support people who use the service need from staff. These plans should set out exactly how staff are expected to prevent and/or deal with such incidents in order protect the people who use the service against the risk of such interventions being unlawful and/or excessive.
Service is not yet fully compliant with the new requirements and codes of practice relating to the prevention and control of infections that were recently introduced under the relatively new Health and Social Care Act.
To protect the people who live and work at Rafael from health care associated infections the proprietor must ensure sufficient numbers of her staff are suitably trained to prevent and control infection and a competent individual is nominated to oversee all the services infection prevention and control arrangements and compile an annual report on the subject.
We are also not satisfied the practice of propping open fire resistant doors during the day complies with the London Fire and Emergency Planning Authorities (LFEPA) regulations regarding fire containment in a residential care setting.
We strongly advise the provider to contact the LFEPA to ascertain if this practice falls within their acceptable standards and if it does not to suggest alternative measures the service can introduce to keep the people who live and work at Rafael Home safe.
Finally, the proprietor needs to submit her registered managers application to the CQC as soon as is reasonably practicable to enable us to consider her 'fitness' to be in day-to-day charge of two care homes at once.