The Care Quality Commission (CQC) has taken further action to protect people using Mitchell’s Care Homes Limited, a care home provider based in Surrey, following inspections of three of their services in November sees them again rated as inadequate.
Rainscombe Bungalow, Rainscombe House and Nutbush Cottage, run by Mitchell’s Care Homes Limited, provide care to people with learning disabilities or autistic people.
These inspections were carried out to follow up on action CQC told the provider to take at previous inspections.
Following these latest inspections, all three services have been rerated as inadequate overall. At Rainscombe House the ratings for effective and caring have dropped from good to requires improvement. Safe and well-led have been rerated as inadequate and responsive has been rerated as requires improvement.
Nutbush Cottage has also been rerated inadequate overall as have the ratings for being safe, caring, responsive and well-led. Effective has improved from inadequate to requires improvement.
Rainscombe Bungalow has been rerated as inadequate overall as have the ratings for safe, effective, caring and well-led. Responsive has been rerated as requires improvement.
CQC have taken significant enforcement action against the provider, which will be reported on when legally able to do so. All three services remain in special measures. This means CQC will continue to closely monitor each service to ensure people are being kept safe, and they will be inspected again to assess whether improvements have been made.
Amy Jupp, CQC deputy director of operations in the south said:
“When we inspected Rainscombe Bungalow, Rainscombe House and Nutbush Cottage, we found that despite issuing enforcement action at all three services, this hadn’t driven the rapid and widespread improvement we wanted it to. Mitchell’s Care Home Limited hadn’t done enough to assure us that people were being cared for in safe, well-led environment.
“All three services weren’t always following safeguarding processes to protect people from harm and abuse. In Rainscombe Bungalow someone told us they witnessed a person saying they wanted to harm themselves. But this hadn’t been recorded in the person's notes as an incident by staff with details of what could be done to support this person or reported to the local authority.
“At Nutbush Cottage we found some staff hadn’t completed safeguarding training although they understood the need to report concerns. They weren’t all able to describe what types of concern they should be aware of. This meant they may not be able recognise concerns they need to report.
“At all three services staff didn’t consistently follow people's care plans putting people at risk of harm. There were occasions where people had a speech and language therapy assessment. The advice was that some people's food should be of a wet consistency, not dry. We saw for ourselves over all three services staff didn’t always follow this guidance and people who needed a soft diet were eating pizza, biscuits and crisps on a regular basis. This put people at risk of choking.
“At a previous inspection of Rainscombe Bungalow last April we told the provider the service felt cold. On the first day of this inspection, we found the home was colder, the windows were open in people's bedrooms and people's hands were very cold to touch. A member of staff told us the radiator in the lounge wasn’t working properly however we found all areas of the service were cold. One person had been supported to bed and was sleeping. However, no bed covers had been placed over them until we asked staff to address this. It’s unacceptable that people living at these services were not being afforded the dignity, and a safe place to live that most of us are able take for granted.
“We’ve reported our findings to the provider, and they know what they must address. We’ll continue to monitor the home closely and will not hesitate to take further action if we’re not assured people are receiving safe and dignified care.”
At Rainscombe Bungalow inspectors also found:
- The risk of malnutrition was not being managed in a safe way. One person had lost a significant amount of weight between April and August 2023. Only when a visiting professional raised this in August, action was taken
- There were people at risk of constipation but there was no formal monitoring of their bowel movements, with one person not having been to the toilet in 12 days
- One person was observed pushing a member of staff's hand away from them and flinching when the member of staff stood up next to them. We raised this with the manager who told us this was a normal behaviour for the person. The person's care plan had no reference to this behaviour. The manager did not ask us for any more information relating to this and we have reported this to safeguarding.
At Rainscombe House inspectors also found:
- One person who had epilepsy was being looked after during the evenings by staff members who had not undertaken epilepsy training or trained in how to use emergency epilepsy medicines. This but people at risk of not receiving the right treatment if they became unwell
- Staff showered one person with the door wide open, demonstrating the poor culture still evident in the service
- There was a lack of a person-centred approach towards people. One staff member rarely engaged with people and some staff didn’t consider someone's dignity by washing them using the sink in a toilet for four months as there was no downstairs shower room.
At Nutbush Cottage inspectors also found:
- One person had been charged a considerable amount for household laundry which they were not required to pay as they were living in a care home. The manager had signed to confirm this transaction was correct. The money was re-imbursed when inspectors highlighted this error. A second person was asked to fund snacks for their birthday tea which would not be considered appropriate in a residential setting
- People's dignity was not always respected. Inspectors saw one staff member approach a person in the lounge to check if they needed the bathroom by looking down their trousers. There were four others in the room at the time including another staff member
- The overall culture of the service was not always respectful and caring towards people and their home. Staff were seen to spend time walking around with minimal interaction as though they were patrolling rather than spending time with people
- During a mealtime inspectors saw one staff member sit to support people and the remaining two staff members stood over the table. One was leaning against the window, and one was stood with their hands behind their back, providing occasional instructions for people to slow down or to take a drink. This appeared institutionalised and did not encourage a mealtime where people could relax.