Rathbone Outreach is a small domiciliary care and supported living service rated Good overall following a focused inspection of safe, responsive and well-led domains in October–November 2023. Well-led was downgraded to Requires Improvement due to failure to ensure housing and support were fully separated in one supported living setting and gaps in quality assurance processes, though the provider took prompt remedial action.
Concerns (5)
moderateRecord keeping: “the provider did not always clearly record the outcome of capacity assessments when people lacked capacity to consent to all aspects of their care and support.”
moderate
Governance
: “The provider's quality assurance processes had not identified the gaps in employment histories we found.”
moderateConsent / capacity: “people's housing and support were not entirely separate...people's ability to have full choice and control”
moderateLeadership: “the provider did not always understand all regulatory requirements and responsibilities.”
minorEnd-of-life care: “not all people had been consulted about their end of life wishes. The provider had recognised this and had plans to make improvements.”
Strengths
· Risks to people's health and wellbeing were managed well and people were included in the risk management processes.
· People were treated with kindness and compassion and received person-centred care from well trained staff.
· Staffing levels were sufficient to maintain people's safety and ensure health and social needs were met.
· Medicines were managed safely with regular checks by managers and prompt investigation of any issues.
· People were supported to maintain relationships, follow their interests and take part in culturally relevant activities.
Quality-Statement breakdown (15)
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuse and avoidable harmGood
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staff; Continuous learning and improving careGood
The Rathbone Centre (Outreach Service) was rated Good across all five key questions at its October 2018 inspection, maintaining the rating from its previous inspection in January 2016. The service demonstrated safe, person-centred care for people with learning disabilities, supported by trained staff, robust governance and a newly introduced flexible support model.
Strengths
· People felt safe and staff treated them with dignity and respect; person-centred risk assessments addressed fire safety, mobility, road safety and community vulnerability
· Medicines managed safely with staff trained, observed and competency-assessed; records confirmed people received medicines as prescribed
· Robust recruitment including DBS checks and service users on interview panels setting their own questions
· Staff received comprehensive induction (4–12 weeks), mandatory and specialist training, regular supervision and appraisal
· Flexible support model introduced in consultation with people, including a drop-in service two days a week, welcomed by people and staff