Rakewood House Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

The service was previously in breach of the legal regulation in relation to staffing. The provider had failed to ensure there were sufficient staff to meet the needs of people living at the home. At this assessment the provider is no longer in breach of this regulation. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

As part of the governance systems the registered manager reviewed events within the home such as accidents and incidents, so any themes and patterns could be easily identified and acted upon. Areas of learning was then shared with the team through team meetings as well as registered manager working alongside the staff. One staff member told us, “Good having [registered manager] on the floor, leading by example.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

A number of people living at Rakewood House required end of life care. The service worked closely with the hospice team to ensure the necessary support, including medication, was available so people received the treatment needed in a dignified manner.

The service also worked closely with the local GP, who would make referrals to other healthcare teams where necessary. Staff said the GP surgery was very supportive and respond to any requests made and would visit the home whenever needed.

Assessments of people’s need were completed prior to the service commencing support. The registered manager met with people and their relatives to establish the support they wanted and needed. People’s records also included a hospital pack and any discharge notes so people’s current and changing needs were clearly communicated.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Systems were in place to ensure people’s rights were upheld and protected. Where necessary, lawful restrictions were in place where people were being deprived of their liberty. People and relatives we spoke with said, “I feel safe because the people are so kind” and “[Relative] feels very safe because the place is secure and there are plenty of staff about.”

The registered manager was aware of their responsibility to report and respond to any concerns raised. Staff knew the process to follow if they had any concerns and felt confident in speaking with the registered manager. Policies and procedures were in place in relation to keeping people safe and protecting their rights. These were supported by training in safeguarding, Mental Capacity Act and deprivation of liberty safeguards and duty of candour.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Areas of risk to people’s health and well-being had been assessed and planned for. Information was kept under review and guided staff in keeping people safe. This was supported by staff training in areas of risk such as pressure care, wound care, nutrition and hydration and in Percutaneous Endoscopic Gastrostomy (PEG) care. This is a feeding tube which provides nutrition and medication through the stomach. Those people we spoke with felt specific areas of care were safely met. One relative told us, “[Relative] is checked every 2 hours and moved to prevent sores; staff also monitor her liquid intake daily.”

Environmental risks were monitored with regular checks to the premises and equipment. An up to date fire risk assessment had been carried out and individual personal emergency evacuations plans had been completed to support people in the event of an emergency arising.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The home was clean and tidy. People had personalised their rooms with belongings from home. The registered manager acknowledged improvements were needed to enhance the environment. This had been outlined within the homes refurbishment plan.

Systems were in place to ensure the safety and suitability of the premises and equipment. Up to date servicing certificates were in place. Maintenance staff also carried out regular checks to ensure the facilities were kept safe and any work required was quickly responded to.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service was supporting an increasing number of people requiring end of life / palliative care. Staff felt at times more staff were needed due to the level of care and support people required. The registered manager said staffing levels were kept under review and would be adjusted to ensure people’s needs were met. People we spoke with acknowledged staff were busy but said their needs were met. One person said, “I think they have enough staff because there is always somebody about the place.” The relative of one person added, “The staff are brilliant. They are run off their feet because there are a lot of people in their rooms needing care, but they do their best.”

New staff completed an induction workbook on commencing their employment. This was supported by a programme of training and development. A programme of supervision was being embedded to help monitor and review staff performance and any further areas of development. The registered manager was also a registered nurse and therefore able to offer clinical supervision as well as assess the competency of nursing staff when carrying out nursing tasks. People and their relatives felt staff were skilled in meeting people’s needs in a safe way. One person told us, “The staff are great, they have to do everything for me dealing with all my personal care. I am being looked after very well.”

The registered manager had formalised monthly team meetings. Staff said these had initially been poorly attended, however, there was now an expectation staff attended. Staff spoken with said these were now attended, the team were more engaged, and this had promoted better teamwork. One staff member commented, “The meetings are very helpful and gives us an opportunity to speak, very productive. All sat around the same table and speaking openly.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Systems were in place to promote good hygiene standards. Relevant training and policies and procedures were available to guide staff in areas such as, food hygiene and infection control. Designated staff were responsible for the cleaning of the home each day. Rooms were clean and tidy and there were no malodours. One person said, “My room is nice and clean.”

Staff wore personal protective clothing when assisting people with aspects of care. Items were cleaned away and disposed of properly.

The provider followed best practice in relation to food safety. The home had been inspected in November 2024 and had received a food hygiene rating of 5, very good.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People received their prescribed medication safely. A clear policy and procedure were in place for the safe management and administration of people’s medicines. Staff completed relevant training and assessments of competency were carried out by the registered manager to ensure practice was safe. Additional training was provided to nursing staff where specialist drugs were to be administered using a syringe driver.

Medicines administration was recorded on an electronic medication record (eMar). From our observations and review of records, we found time specific medicines being administered as prescribed. Suitable arrangements were in place for the safe storage of controlled drugs. A random check of stocks was completed. These corresponded with records held. However more suitable arrangements were needed for the safe disposal of medicines no longer required. The provider should refer to NICE guidance which states ‘medicines for disposal should be stored securely in a tamper-proof container within a cupboard until they are collected or taken to the pharmacy’.

Medication administration records were audited to check people had received their medicines as prescribed. Protocols were in place for ‘when required’ medicines. Information needed expanding upon to guide staff when this should be used, particularly for those people unable to advocate for themselves.

People we spoke with said they received the support they needed in managing their prescribed medicines. One person told us, “I get medication for my epilepsy, and I am satisfied with how that is dealt with.” The relative of another resident also added, “She gets all her meds given to her by the nurse and to my knowledge, there has never been a problem with that.”