CQC report explained · a residential care home
What the CQC found at The Rambles Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff, suitable risk assessments, safe medicines records and appropriate recruitment checks. They also found improvements to water temperatures and radiator safety.
- Effective?
- Good
- This question was not separately rated in this inspection.
- Caring?
- Good
- This question was not separately rated in this inspection, although inspectors reported person-centred care and positive comments from relatives.
- Responsive?
- Good
- This question was not separately rated in this inspection.
- Well-led?
- Good
- The home had management and monitoring systems, and inspectors found a positive, open and person-centred culture. They noted that the medicines audit had not identified the missing body map before the inspection.
What inspectors found, August 2021
The Rambles Care Home was rated Good; inspectors found safe, person-centred care, with minor issues around medicines records and mask use.
The inspection took place on 2 July 2021 and was announced 48 hours in advance. One inspector visited, observed care, looked around the home and garden, spoke with people, staff, the manager, relatives and health professionals, and checked care, medicine, recruitment and quality records.
The home was rated Good overall. Safe and Well-led were both rated Good. Inspectors found enough staff, suitable risk assessments, safe medicines practice and a clean environment. People had information about their communication, health needs and preferences.
The home had improved since the previous inspection, when it was rated Requires improvement. Improvements included safer radiators and water temperatures, refurbished bathrooms, a new boiler and radiators, decoration, new outdoor seating and a vegetable patch.
Inspectors found two issues that needed attention. One person did not have a body map showing where a topical cream should be applied, although this was put right after the inspection. One staff member was also seen handling their face mask unsafely, and the manager said action had been taken.
Safe staffing and care
There were enough staff, and staff knew people's needs well. Recruitment checks were completed before staff started work.
“People were supported by enough staff and by staff who knew them well.” from the report
Person-centred support
Care plans included information about people's communication, health needs, interests and preferences. The home aimed to support choice and independence.
“The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.” from the report
Environmental improvements
The home had improved safety and comfort since the previous inspection, including safer radiators, refurbished bathrooms and improvements to the garden.
“Various improvements had been implemented following our last inspection.” from the report
Positive relationships
Relatives spoke highly of the support and communication. People were supported to keep in contact with loved ones during the pandemic.
“People were supported to stay in contact with their loved ones throughout the pandemic.” from the report
Missing topical cream guidance
needs fixingOne person needed a body map to show staff where to apply a topical cream. This was not in place during the inspection, but the manager arranged it afterwards.
“One person required a body map giving staff guidance on where to administer their topical cream.” from the report
Mask handling
minorAn inspector saw one staff member lower their mask below their chin to drink and then put it back up while within two metres of a person. The manager said action had been taken afterwards.
“We were not always assured that the provider was using PPE effectively and safely.” from the report
Medicines audit
needs fixingThe medicines audit had not identified the missing body map before the inspection. Inspectors said the audit could be improved so similar shortfalls are found sooner.
“The providers medicines management audit could be improved so that any shortfalls like this in the future are identified.” from the report
- 01How do you now check that topical cream body maps and other medicine instructions are complete and up to date?
- 02What action was taken after the inspection about staff wearing and handling face masks?
- 03How do you check that infection prevention procedures are followed during visits and everyday care?
- 04How are people's communication passports, hospital passports and risk assessments kept up to date?
- 05What improvements have been made since the previous Requires improvement inspection, and how do you check that they are lasting?
This inspection rated Safe and Well-led only; Effective, Caring and Responsive were not separately rated in this report. This explanation was written from the published report of 6 August 2021 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, February 2020
Rated Requires Improvement; inspectors found kind, personalised care but safety checks missed risks of scalding.
The inspection took place on 30 December 2019 and 3 January 2020. It was unannounced on the first day. Inspectors spoke with one person, staff and the manager, and received feedback from relatives and a health professional. They also reviewed care records, recruitment files and management records.
The home supported people well in several areas. Staff were kind, knew people well and supported their choices, health appointments, activities and contact with family. Care plans were personalised, medicines records were accurate, and people were supported by enough staff.
However, the home was not always safe. Hot water and some radiators were hot enough to cause scalding or burns. Risk assessments and quality checks had missed these issues, as well as gaps in hand-washing arrangements and one person's risk from ingesting liquids.
The overall rating changed from Good at the previous inspection to Requires Improvement. Safe and well-led were rated Requires Improvement. Effective, caring and responsive were rated Good.
Kind and respectful staff
Inspectors saw staff spending time with people and speaking about things that mattered to them. People appeared clean and well presented.
“People were supported by staff who demonstrated a kind and caring approach towards them.” from the report
Personalised care
Care plans included people's history, preferences, communication methods and routines. They helped staff support people to have a good day.
“People's care plans were person centred and were detailed and informative.” from the report
Support with health
Staff knew people well and helped them attend appointments. Referrals were made to health professionals when needed.
“Referrals were made when required to physiotherapists, occupational therapists, dentists, GP's and other professionals.” from the report
Medicines managed safely
Medicines were stored securely and records were accurate. Staff received training and checks on their medicines practice.
“Medicine's administration records (MARs) were accurate and up to date.” from the report
Activities and family contact
People were supported to take part in activities they valued, visit places they enjoyed and keep in touch with family.
“People were supported to remain in regular contact with their families.” from the report
Scalding and burn risks
seriousHot water exceeded recommended temperatures for two people. Some radiators were too hot to touch and were close to a chair used by one person.
“People and staff could be at risk of hot water that posed a risk of scalding due to temperatures exceeding recommended temperatures.” from the report
Checks missed safety problems
needs fixingThe home's health and safety audit and daily checks had not identified the hot water and radiator risks. This led to limited assurance that safety was being managed.
“The provider's Health and safety audit completed August 2019 had not identified issues with hot water exceeding safe temperatures.” from the report
Gaps in infection-control risk assessment
needs fixingLiquid soap was not available in communal toilets because of a person's risk of ingesting it. The assessment did not properly set out how effective hand washing would be managed.
“The environmental risk assessment had not identified this issue or what actions staff should take for effective hand washing.” from the report
Missing personal risk assessment
needs fixingOne person did not have a risk assessment covering the danger of ingesting liquids. The manager sent an assessment after the inspection.
“There was no personal risk assessment in place for the person and the risks associated with ingesting liquids.” from the report
Bedroom privacy
minorOne person had no bedroom curtains after an earlier incident. The manager said replacement curtains with a Velcro seam had been ordered.
“However one person had no bedroom curtains. This had been following an incident where they had been pulled down.” from the report
- 01What checks are now in place to keep hot water within safe temperatures?
- 02How are radiator temperatures checked, especially near chairs or places where people sit?
- 03How is effective hand washing provided in communal toilets and bathrooms?
- 04How often are people's personal and environmental risk assessments reviewed and updated?
- 05What progress has been made on filling the two full-time vacancies and the additional one-to-one care hours?
This was a planned inspection of the whole service, including care and the premises, and all five CQC questions were rated. This explanation was written from the published report of 11 February 2020 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 The Rambles Care Home
4 rated inspections over 7 years: the service has held its Good rating throughout.
- August 2021Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2020Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- June 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2014GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 12 November 2010.
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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