CQC report explained · a residential care home
What the CQC found at No 19 Respite House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found risks linked to epilepsy care, rescue medicines, medicine storage and fire safety. They also found that medicine audits had not identified these problems.
- Effective?
- Requires improvement
- Staff had relevant skills, but training records had gaps and induction records were incomplete. Inspectors also found that restrictions on one person were not supported by a clear legal process.
- Caring?
- Good
- People were treated with kindness, dignity and respect. Staff knew people's needs and preferences and supported them to make choices and build independence.
- Responsive?
- Good
- Support was personalised and flexible. People could attend work placements, appointments and day centres, and were supported with activities, communication and relationships.
- Well-led?
- Requires improvement
- Managers and staff were committed to people's wellbeing, but quality monitoring was not robust enough. It failed to identify concerns about risks, medicines, legal safeguards, induction and fire safety.
What inspectors found, August 2022
Rated Requires Improvement; inspectors found kind, flexible care, but identified safety, medicines and management weaknesses.
This was the first rating inspection of the newly registered service. It was an unannounced visit on 13 June 2022. One inspector spoke with people, relatives, staff and managers, and checked care records, medicines, training and quality checks.
People were treated with kindness and respect. They had choices about their daily activities, food and support, and were helped to stay independent and connected with their community. The home also supported people's communication needs and healthcare arrangements.
Inspectors found important gaps in safety. These included missing guidance for epilepsy risks and rescue medicines, unsafe medicines arrangements, and fire doors that did not initially have suitable closing devices. The home also did not have reliable systems for checking quality, records, staff induction and legal safeguards.
Kind and respectful support
People had positive relationships with staff and were treated with dignity. Staff understood people's individual needs, preferences and communication.
“People told us they looked forward to staying at No 19 and we saw people were treated with kindness” from the report
Choice and independence
People could choose how to spend their time and were encouraged to take part in daily tasks and activities in the local community.
“People were able to choose how they spent their time and were supported by staff to take part in activities and pursue their interests in their local area/community.” from the report
Flexible, personalised care
Support was adapted to people's routines and wishes. People could continue with work placements, appointments and day centres during their respite stay.
“People received individualised care and support in a way that was flexible and responsive to their needs.” from the report
Communication support
Support plans described how people communicated, and the home provided information in easy-read formats.
“The provider had developed information in an easy read format.” from the report
Epilepsy and rescue medicine guidance
seriousStaff did not initially have written guidance about managing one person's epilepsy or when to give rescue medicine. The manager later said that plans and a protocol had been put in place.
“At the time of the inspection staff had not been provided with any written guidance on how and when they should administer this medicine.” from the report
Medicines management
seriousMedicines were not always stored or managed safely. One person's medicines had been moved into a weekly compliance aid before the respite stay, creating a risk.
“Medicines management and administration posed a risk to people as systems did not follow good practice and guidance from the Royal Pharmaceutical Society.” from the report
Fire safety
seriousSeveral doors did not initially have fire door closers. The provider later confirmed that suitable closing devices had been fitted.
“During a tour of the property, we noted that several doors within the service had not been fitted with a fire door closure.” from the report
Quality checks and records
needs fixingThe home's audits and monitoring systems did not identify the problems found by inspectors. Records were not always accurate, complete and up to date.
“We found systems and processes to monitor the service were not undertaken robustly.” from the report
Staff induction records
needs fixingThe manager said staff had completed induction, but the paperwork was not complete enough to confirm this reliably. CQC recommended that the provider review its induction systems.
“We found induction documentation could not be relied upon as this had not been fully completed.” from the report
- 01What evidence can you show that epilepsy care plans and rescue medicine protocols are now complete and available to every relevant staff member?
- 02How are medicines supplied, stored, recorded and checked during each respite stay?
- 03What legal authorisation is now in place for any restrictions or one-to-one supervision?
- 04Have all fire doors and other environmental safety issues been checked and signed off?
- 05How do your audits now identify problems with care records, staff induction and medicines before they put people at risk?
This was the first planned rating inspection and covered all five CQC questions, including the premises and the care provided. This explanation was written from the published report of 6 August 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of No 19 Respite House
Each visit the CQC has published, newest first, back to the day the home was registered.
- August 2022Requires improvementcurrent ratingSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2021
Registered with the Care Quality Commission on 1 April 2021.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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9 live-in carers within about an hour of Plymouth
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
8 can care for a couple. 9 years' experience on average.
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.