Archived: Rapkyns Care Centre Also known as The Grange

Updated 4 February 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 three inspectors and a nurse specialist on 15 and 16 December 2020. On 17 December 2020 two inspectors carried out the inspection. During the site visit and afterwards the inspection was supported by a member of CQC’s medicines optimisation team.

Service and service type

Rapkyns Care Centre 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.

The service had a manager registered with the Care Quality Commission, but they had left in August 2020 and were not in day to day control of the service. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. 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. We took this into account when we inspected the service and made the judgements in this report.

We used all of this information to plan our inspection.

During the inspection-

We spoke with three people who use the service and observed care and support. We spoke with the chief operating officer, the clinical lead and the provider’s nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with 11 staff, and the chef. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

After the inspection

We reviewed copies of people’s care and records, training records, rotas, incident reports and audits. We spoke with the chief operating officer, clinical lead and the provider’s nominated individual. We also spoke with three support workers, two registered nurses and four relatives of people using the service via telephone.

Updated 4 February 2021

Rapkyns Care Centre is a residential care home providing personal and nursing care for up to 41 people with physical disabilities, autism, and profound multiple learning disabilities. At the time of our inspection there were 24 people living at the service.

Rapkyns Care Centre is located in Rapkyns Care Village, which is a community set behind a locked gate on the outskirts of Broadbridge Heath. The whole Rapkyns Care Village, which contains four care homes, is operated by Sussex Healthcare. Rapkyns Care Centre (also known as The Grange) is comprised of four lodges, each with a dining area, lounge and bedrooms. During our inspection one of the lodges had been temporarily closed.

Rapkyns Care Centre 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 previously raised, the provider is currently subject to a police investigation. The investigation is on-going, and no conclusions have yet been reached.

People’s experience of using this service and what we found

People were not always kept safe at Rapkyns Care Centre. We found concerns with the safe management of risk for areas including behaviour that may challenge others, eating and drinking, feeding tubes, epilepsy care, skin integrity, and physiotherapy.

People were not consistently kept safe from the risk of abuse or neglect. We found issues with people not receiving their medicines when they should or receiving them in an unsafe way.

There were not enough permanent nurses or physiotherapy staff deployed to meet people’s needs safely. Infection control concerns were identified in relation to some agency nurses not having correct training to use specialist personal protective equipment (PPE). Lessons were not being consistently learned and similar issues to those highlighted at other inspections and locations managed by the provider were found at this inspection.

Staff training was not effective as some staff did not have a good understanding of some people’s conditions and the support they would need, such as autism. People’s health needs were not consistently being supported effectively. We found concerns with people’s feeding tubes, checking on people and monitoring their changing health needs.

People were not supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People had medicines crushed and other restrictions in place without having MCA assessments and best interest meetings.

People were not consistently supported in a way that upheld their dignity. We observed some poor interactions between one staff and some people. Some people had been left for long times in their incontinence pads, for up to 10.5 hours.

There was not a person-centred approach to supporting people at Rapkyns Care Centre. One person with autism was being left for long periods with very little or no staff support or stimulation. Activities were not personalised and were often group craft activities that people passively watched.

There was no evidence of continuous learning. Six regulations had been breached since earlier inspections dating back to September 2018 and February 2019. Urgent conditions CQC imposed on the provider’s registration had not resulted in improved standards of care and safety.

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.

Despite our continuing concerns, people’s relatives were consistently positive in their praise for the service. One relative told us, “If it was not for Rapkyns [name] would not be with us. To know [name]’s in that environment I am lost for words that it means so much to us that she is safe and happy and is living instead of existing. We’ve seen what it could be like and nothing compares to Rapkyns.” A second relative commented, “Even though we’ve had [name] home every third weekend, she hasn’t been home during Covid and has remained happy. They (Rapkyns) have proceed to be a wonderful family for her.” A third relative said, “During summer [name] had to go to hospital for a visit and had to self-isolate on return…We told staff [name] loved sunbathing and next day we video called and [name] was laying with sun cream on and music plying.”

People had enough to eat and drink and the chef knew people’s needs well. People were able to move into the service or move on to other services. Staff supported an effective exchange of information by sharing care plans. There had been lots of assessments by funding authorities that had been facilitated.

There was a complaints procedure in place and any complaints were logged, responded to and resolved in line with the provider’s policy. Nobody at Rapkyns Care Centre was receiving end of life support but plans were available to people and their families who wanted them.

There had been a lot of work done to assess people’s needs around physiotherapy and to recruit to vacant physiotherapy posts. There were knowledge checks and safety huddles implemented by the new management team to try and increase staff knowledge and promote best practice, although the management team acknowledged this was a work in progress

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and

Independence

The service was in private grounds in the countryside behind a locked gate. There were limited opportunities for people to access the local community. Staff wore uniforms and name badges to show they were care staff when supporting people.

The service was bigger than most domestic style properties. There were signs on the road before the service’s private drive, in the grounds and on the exterior of the service to indicate it was a care home.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human

Rights

People were not always supported safely.

People’s support was not always dignified.

Staff did not always respond in a compassionate or appropriate way when people experienced pain or distress.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people

using services lead confident, inclusive and empowered lives

The culture was not person centred or empowering. Staff tended to do things for people rather than with them.

The management team understood the challenges facing the service but there was significant work to do to raise safety standards and to provide good care.

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 Inadequate (published 11 September 2020) and there were multiple breaches of regulation. The service had been rated Requires Improvement or Inadequate for the last four inspections. At this inspection not enough improvement had been made we identified seven breaches of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to person centred care, dignity, consent, safe care and treatment, safeguarding people from harm, good governance and staffing at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will act in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rat