An Essex care home has been told its service requires improvement after it was discovered that a lack of effective governance and mishandling of medicines had led to breaches of both the Mental Capacity and Health and Social Care Acts. Rawreth Court in Rayleigh, run by the Essex Partnership University NHS Foundation Trust (EPUT) was rated as 'requires improvement' by the Care Quality Commission (CQC). The home provides accommodation as well as personal and nursing care services to 34 older people who are living with dementia, and who may also have additional mental health needs.
The CQC's inspection report, published on November 8 after site visits were conducted throughout September, detailed how breaches were identified in a number of areas including incidents relating to consent, medicines management, dignity and respect. The service's criteria for the safe, effective, caring and responsive sections of the inspection were rated as 'requires improvement', with the 'well-led' question recognised as 'inadequate'.
According to the report; "staff training was not embedded in [Rawreth Court's] everyday practice... people were not always treated with dignity and respect, were not supported to have maximum choice and control over their lives and staff did not support them in the least restrictive way possible". Records kept showed that between August 23 and September 7, 11 people at Rawreth Court had not received some of their medicine due to particular brands or drugs being out of stock or unavailable. In addition to this, staff members had been observed administering medication without washing their hands or using sanitiser before or after the fact.
Another patient was administered the wrong respiratory inhaler with the appointed care staff member using the wrong technique, and a further two patients had their respective medications crushed up and mixed before these were administered. In all cases, the information provided in patients' care plans was sparse and various medicinal records were not up to date.
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The CQC also identified signs of a 'closed culture' at the centre, which included all bathroom and toilet doors being locked. This resulted in all residents needing to be accompanied to the bathroom by a member of staff if they wished to use the facilities. Staff did not ensure fluids were freely available throughout the day, and no needs assessments were undertaken to ensure those at risk of malnutrition or dehydration were receiving the correct amounts of food and fluids to mitigate this concern. One staff member was observed rushing a resident whilst they were supervising their meal time, which could have caused a choking risk.
With further consideration of meal times and routines, CQC said: "Care was not always delivered in a way which respected the person being supported or maintained their dignity. No consideration was given to treat people as individuals".
Staff members were observed to stand above residents while assisting them with eating rather than remain at eye level. One person said that staff "bring [them] a drink with a lid on to suck from, but [they are] not a baby". After inspecting Rawreth Court's leadership and governance, CQC said they found "widespread significant shortfalls in service leadership", and that it was not clear where and if the service had been compliant with regulations. The report continued by stating that "the provider's lack of oversight failed to ensure appropriate and prompt actions were taken to address staff's poor medicines practice".
Despite these failings, relatives of residents said that they felt their family members were "100 per cent safe" at Rawreth Court, and that in terms of communication, service staff would always ensure relatives would "get a call if anything is not right". Correct recruitment practices were followed, and cleanliness in the home was kept to a high standard.
A spokesperson for EPUT said: “We’re committed to working with the CQC, our partners, and patients and their families to continually improve the care we provide and have taken immediate action to address feedback to ensure patients at Rawreth Court receive the safe and compassionate care they deserve.
“Since the inspection in September, we have strengthened processes around the safe administration of medication, improved the recording of patient risk assessments and refreshed staff training across a number of areas to enhance quality of care for all patients.”
