Background to this inspection
Updated
13 March 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by two inspectors.
Service and service type
Rapkyns Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Notice of inspection
This inspection was announced. We gave the service 24 hours’ notice of the inspection. This was to establish the safest and most appropriate way of carrying out our inspection visit during the COVID-19 pandemic.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. Before the inspection we reviewed the information, we held about the service and the service provider. We looked at the notifications we had received for this service. Notifications are information about important events the service is required to send us by law. We used all this information to plan our inspection. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with three people who used the service and three relatives about their experience of the care provided. We spoke with nine members of staff including the nominated individual who is the person responsible for supervising the management of the service on behalf of the provider. We also spoke to the manager, quality manager, senior care workers, care workers, agency care workers and activity co-ordinators. We observed the support and interaction people had with staff and used this to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including accident and incident reports, management audits and policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with three professionals who regularly visit the service.
Updated
13 March 2021
About the service
Rapkyns Nursing Home provides nursing and personal care for up to 60 people living with a learning disability, physical disability or complex health condition.
Accommodation is provided in two buildings on the same site and comprises the main building, called Rapkyns Nursing Home, and a smaller building, called Sycamore Lodge. At the time of this inspection, there were no service users living at the Rapkyns Nursing Home building so this inspection is only about what we found for people living in Sycamore Lodge. Sycamore Lodge is a service that provides residential care and support for up to 10 people with a learning disability and autism, with some behaviours that may challenge others. At the time of our inspection, six people were living at the service. Accommodation is provided on one level. Communal areas include a lounge area and dining room, with access to gardens and grounds. All rooms have en-suite facilities.
Rapkyns Nursing Home is owned and operated by the provider Sussex Healthcare. Services operated by the provider had been subject to a period of increased monitoring and support by local authority commissioners. As a result of concerns raised, the provider is currently subject to a police investigation in relation to incidents that occurred between 2016 and 2018. The investigation is on-going, and no conclusions have yet been reached.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
Right support:
• Model of care and setting maximises people’s choice, control and
Independence
Right care:
• Care is person-centred and promotes people’s dignity, privacy and human
Rights
Right culture:
• Ethos, values, attitudes and behaviours of leaders and care staff ensure people
using services lead confident, inclusive and empowered lives
For example; Meals are cooked in another building and arrive at Sycamore lodge in heated boxes. People cannot be involved in the preparation of their meals or enjoy the anticipation of meals which comes with the smell of food cooking. The service is isolated from access to ordinary community activities such as shops, public transport and entertainment venues. People cannot easily access the local shop or pub; these activities need the use of a vehicle which must be planned which does not allow for spontaneity. This is particularly important where people make choices in the moment and have difficulty understanding the passage of time.
People's experience of using this service and what we found
We found that the service was not always constantly safe and well led. People were not always supported consistently by people who knew them well and there was a high reliance on agency staff.
Improvements had been made since the last inspection, although these had not yet been fully embedded into practice as the service is still reliant on high levels of agency staff. People spoke confidently about the manager and were positive in their feedback. Staff had an enthusiastic and caring approach to their work, which was observed at inspection. Care plans and risk assessments had been updated and reflected people’s needs, giving detail on health needs and guidance for staff to follow.
Positive behaviour support plans were now in place with staff aware of the content and incidents of behaviours that pose a risk to an individual or others had reduced.
Incidents and accidents were being audited by the manager and actions taken to follow up on concerns.
People were treated in a kind and caring way by staff. People's dignity was maintained by staff who supported people in a sensitive way.
People had been protected from abuse and staff knew their role in reporting concerns. There were enough staff deployed on each shift to keep people safe and infection control measures were effective.
The provider had been submitting a monthly report to CQC as part of the conditions imposed on this location.
Some relatives felt that the provider could do more to engage them and seek their views.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update.
The last rating for this service was Requires improvement. Published (16 June 2020).
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to quality monitoring, the effectiveness of audits.
Why we inspected
This was a planned inspection based on the previous rating. We also followed up on action we told the provider to take at the last inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.