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CQC report explained · a nursing home, run by Essex Partnership University NHS Foundation Trust

Rawreth Court

Rawreth Lane, Rayleigh, SS6 9RN

Requires improvementpublished 10 November 2023, 2 years ago

Rated Requires improvement: inspectors found the service was not performing as well as it should and told it what to change.

The five questions inspectors ask
Safe?
Requires improvement
Inspectors found that 11 people had missed some medicines because they were unavailable or out of stock. Risk assessments and moving and handling practice were also not always safe, although staffing, recruitment and infection control arrangements were suitable.
Effective?
Requires improvement
The home did not consistently follow the Mental Capacity Act or use the least restrictive approach. Staff training was not embedded in daily practice, and people's nutrition and hydration were not always properly supported or monitored.
Caring?
Requires improvement
People were not always treated with dignity or respect, including during meals and through the use of the same plastic beakers and cutlery for everyone. Most relatives and some people nevertheless described staff as kind and caring.
Responsive?
Requires improvement
Care plans did not always contain current, personalised information about people's dementia, mental health, communication or end-of-life needs. People did have access to activities, family visits and healthcare services.
Well-led?
Inadequate
Governance and quality checks did not reliably identify or correct problems. Inspectors found that lessons had not been learned and that several breaches from the previous inspection continued.
The latest report, explained

What inspectors found, November 2023

Overall Requires Improvement; inspectors found unsafe medicines practice and care shortfalls, while well-led was rated Inadequate.

This was an unannounced inspection in September 2023. Inspectors visited on three days, spoke with people, relatives and staff, and reviewed care records, medicines records, staff files and management information.

The home had enough staff on duty and recruitment checks were completed. Infection prevention arrangements were suitable, people could receive visitors, and staff worked with health professionals. Relatives and most people also described care as kind.

However, inspectors found missed medicines, unsafe moving and handling, incomplete risk assessments, poor monitoring of nutrition and fluids, and care records that were not always accurate or complete. People were not always treated with dignity, and some restrictions were imposed without the required consent or best-interest decisions.

The overall rating remained Requires Improvement, as it had been in 2019. Safe, effective and responsive also remained Requires Improvement. Caring fell from Good to Requires Improvement, while well-led fell from Requires Improvement to Inadequate. The provider was still in breach of regulations from the previous inspection.

What inspectors praised

  • Infection control

    The home had suitable arrangements for preventing and managing infection, with enough protective equipment available.

    “We were assured the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report

  • Activities and relationships

    People took part in group and one-to-one activities, and staff supported relationships with family and friends.

    “People were observed to participate in group activities and to receive one to one support.” from the report
What inspectors were concerned about

  • Medicines were not always safe

    serious

    Eleven people missed some medicines because supplies were unavailable. Inspectors also saw errors in administration, insecure storage and incomplete medicines information.

    “We found 11 people had missed some of their medicines between 23 August 2023 and 7 September 2023, as these were either not available or out of stock.” from the report

  • Risks were not properly assessed

    serious

    Some risks were not recorded or did not explain how staff should reduce them. Inspectors also saw unsafe moving and handling.

    “Arrangements were not robust to manage and mitigate risk for people using the service.” from the report

  • Restrictions and consent

    serious

    Bathroom and toilet doors were locked, and bedroom door alarms continued to be used without recorded consent or best-interest decisions. Some DoLS applications were also not renewed on time.

    “We identified signs of a 'closed culture' whereby blanket restrictions were imposed and were not the least restrictive option.” from the report

  • Nutrition and hydration

    serious

    Drinks and snacks were not always freely available, people's fluid intake was not properly recorded, and one person was rushed while eating.

    “Staff did not ensure people's hydration levels were maintained in line with their assessed needs.” from the report

  • Dignity during care

    serious

    People were given the same plastic beakers and cutlery without enough attention to individual dignity. Staff were also seen standing while helping people eat instead of sitting at eye level.

    “People were not always treated with respect and dignity.” from the report

  • Poor oversight and care records

    serious

    Audits and governance systems did not identify or resolve repeated problems. Care plans were incomplete, inaccurate or out of date.

    “The lack of effective oversight and governance of the service at both provider and service level, has resulted in several continued breaches of regulation.” from the report
Questions to ask them, based on this report
  1. 01What action has been taken to ensure medicines are always available, correctly administered, securely stored and accurately recorded?
  2. 02How are individual risks now assessed and recorded, including moving and handling, distress, fire evacuation and medicines?
  3. 03How do you check that restrictions such as locked doors or alarms are lawful, individually assessed, consented to or made in the person's best interests?
  4. 04How are people's food and drink choices, fluid intake and safe eating now monitored?
  5. 05What changes have been made to care plans and quality audits since the warning notices, and how will you show that these changes are working?

This was an unannounced follow-up inspection covering all five key questions and infection prevention and control, after the previous Requires Improvement rating published in 2019. This explanation was written from the published report of 10 November 2023 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.

The story over the years

Every inspection of Rawreth Court

2 rated inspections over 5 years: the service has held its Requires improvement rating throughout.

  1. November 2023Requires improvementcurrent ratingstayed Requires improvement
    Safe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate

    Read what inspectors found at Rawreth Court →

  2. March 2019Requires improvement
    Safe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement

    We are reading this report · the original is on cqc.org.uk

  3. March 2017

    Registered with the Care Quality Commission on 31 March 2017.

Ratings and report dates from the Care Quality Commission. A service can also be visited without a new rating being published, so the timeline shows published inspections, not every contact the CQC has had with the service.

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