CQC report explained · a residential care home
What the CQC found at Rascasse
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- Risks were assessed and staffing and recruitment were suitable, but safety plans were not always followed consistently. A fire door had been wedged open, and medicine records did not always show carried-forward medicine clearly.
- Effective?
- Good
- Staff received induction, training, supervision and competency checks. People had appropriate support with nutrition, health care, consent and mental capacity decisions.
- Caring?
- Good
- Staff were kind, patient and respectful. People were supported by familiar staff who understood their communication methods, choices, privacy and dignity.
- Responsive?
- Good
- Care plans were detailed and regularly reviewed with relatives involved. People were supported with personalised routines, community activities, communication and relationships.
- Well-led?
- Good
- There was a clear management structure and relatives and staff described managers as approachable. Audits, feedback and action plans were used to monitor and improve the service.
What inspectors found, July 2018
Rascasse was rated Good overall, but inspectors found safety practices needed improvement, especially fire checks and medicine records.
Inspectors visited on 6 and 22 June 2018 without announcing the visits. They observed care, spoke with staff, managers and relatives, and checked care records, medicines, staff files, rotas, training and quality checks.
The home was rated Good for Effective, Caring, Responsive and Well-led. Staff knew people well, treated them kindly and supported personalised activities, communication, health care and daily choices. Relatives gave positive feedback.
Safe was rated Requires Improvement. Inspectors found improvements since the previous focused inspection in March 2017, and the home was no longer breaching the regulations. However, a fire door had been wedged open, fire safety auditing needed strengthening, and medicine recording was not always consistent.
Kind and patient staff
Inspectors saw staff respond calmly and kindly when someone became anxious. Staff understood people's individual ways of communicating.
“Staff were alert to the risks but responded to the individual in a kind and patient way and gave them the time that they needed to calm down.” from the report
Personalised support
Care plans gave staff detailed guidance about people's routines, preferences and signs of anxiety. Relatives were involved in reviews.
“Relatives told us that they were involved in developing the care and support plans.” from the report
Meaningful activities
People took part in activities suited to their interests, including walks, shopping and swimming.
“During our inspection, we observed people being supported to access a variety of community activities, including walks in the local area, shopping and swimming.” from the report
Improved incident management
Compared with the previous inspection, managers had a clearer understanding of being open about safety incidents and identifying learning.
“At this inspection we found that improvements had been and the management of the service was clearer as to their responsibilities to be open and identify learning” from the report
Skilled staff support
Staff had training and supervision relevant to people's complex needs, including learning disabilities, epilepsy and distressed behaviour.
“Staff received ongoing training and supervision to reflect on their practice and ensure that they had the skills and knowledge to meet people's complex needs.” from the report
Fire safety practice
seriousA door in the annex had been held open with a wedge, despite this having been raised before. The manager removed the wedge and fitted an automatic door closer, but inspectors recommended stronger fire safety auditing.
“However, we found a door propped open with a wedge during the inspection.” from the report
Medicine records
needs fixingMedicines were stored and administered safely, but staff did not always record carried-forward medicine consistently. Inspectors recommended stronger auditing so errors are identified quickly.
“Staff however were not consistently recording carried forward medicine which meant that when we checked the medicine for one individual this did not tally.” from the report
Risk plans not always followed
needs fixingInspectors found evidence of good risk management, but plans were not always implemented consistently.
“Risks to people were assessed and while there was evidence of excellent practice management plans were not always consistently implemented.” from the report
- 01How do you now check that fire doors and other fire safety arrangements in the annex are used correctly?
- 02How are carried-forward medicines recorded, and how often are medicine records audited?
- 03How do you check that each person's risk management plan is being followed by every member of staff?
- 04What improvements were made after the March 2017 focused inspection, and how do you know they have lasted?
- 05How are relatives involved in reviewing care plans and checking progress?
This was an unannounced inspection covering all five key questions and the overall rating; it followed a focused safety inspection in March 2017. This explanation was written from the published report of 26 July 2018 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.
What inspectors found, April 2017
Rated Good overall, but inspectors found that safety risks, incident investigations and medicines management needed improvement.
This was an unannounced, focused inspection on 20 March 2017. Inspectors looked at safety after receiving information about an incident. They observed care, spoke with relatives and staff, and checked care plans, medicines, recruitment and safety records.
The home had enough staff and people had good access to the community. Relatives spoke positively about the kindness of staff, and staff understood safeguarding concerns.
However, risk plans for distressed behaviour were unclear and staff practice was inconsistent. Fire safety arrangements were not always followed, environmental risks were found, and records for some medicines did not match prescriptions. Incident investigations were not open or thorough enough.
The home was rated Good overall, but Safe was rated Requires Improvement. The report says the overall rating was carried forward from the previous comprehensive inspection, while this inspection only covered Safe.
Staffing and community access
Inspectors found enough staff to support people safely and enable them to take part in community activities.
“people had good access to the community and the staffing levels enabled people to lead full lives.” from the report
Kind and familiar staff
Relatives were positive about the staff and the manager. Inspectors observed people appearing at ease with staff.
“the service benefited from a stable staff team and approachable manager.” from the report
Safeguarding awareness
Staff understood what abuse could involve and said they knew how to raise concerns.
“Staff had a good understanding of safeguarding issues, and the steps that they should take if a concern was identified.” from the report
Risk plans and incident response
seriousRisk plans were not clear enough and staff did not always follow the same approach. The home had not fully reviewed incidents or provided clear ways to get help during community incidents.
“We were not assured that the service was taking all the necessary steps to anticipate and minimise risks to keep the person safe” from the report
Fire and environmental safety
seriousFire doors were propped open, and other environmental concerns included unsecured knives and chemicals, poor cleaning and a lack of handwashing facilities in the laundry.
“door wedges in use throughout the building which could compromise the fire safety systems in the event of a fire.” from the report
Medicines records
seriousThe records for medicines given when needed did not match what had been prescribed. This created a risk that someone could receive the wrong amount.
“an anomaly between what was prescribed and what was recorded on the medication administration chart.” from the report
Incident investigations
seriousInvestigations were not sufficiently open, objective or focused on learning. The report says the provider did not fully understand its duty to be open and transparent after safety incidents.
“the investigation into the incident had not been as objective as it could have been” from the report
- 01What has changed in the risk plans and staff procedures for distressed behaviour and incidents in the community?
- 02How do you make sure the correct number of staff support each person when going out?
- 03How are medicines given when needed checked against current prescriptions?
- 04What action has been taken to stop fire doors being propped open?
- 05How do you now investigate incidents and show that learning has been shared with staff?
This was a focused inspection prompted by concerns about safety and covered Safe only; the overall Good rating and other areas came from the previous comprehensive inspection. This explanation was written from the published report of 26 April 2017 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 Rascasse
3 rated inspections over 2 years: the service has held its Good rating throughout.
- July 2018Goodcurrent ratingstayed GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2017Goodstayed GoodSafe: Requires improvement
- April 2016GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- December 2011
Report published without a new overall rating.
- May 2011
Registered with the Care Quality Commission on 18 May 2011.
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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