Report criticises Rapkyns Nursing Home

The Guildford Road nursing home specialises in caring for people with neurological conditions - at the time of the inspection, the home had 23 residents with Huntington’s Disease, and 22 with other conditions.

Such conditions can make it hard for a patient to consent to treatment or, when the condition progresses, to consent to treatment being stopped.

The report describes three major issues: “We found that when people became unwell appropriate medical advice was sought,” it says.

“Staff had a good understanding of when to contact a doctor for advice. However, people’s rights with regard to consent were not being met by the service and staff were not provided with training relating to consent.

“This resulted in staff not understanding how people’s capacity should be considered. They did not ensure when people lacked capacity, that best interest meetings were held with people who knew and understood the person.

“Capacity and consent procedures were not followed in practice and monitored for people who were unable to give, or chose to withhold, consent to care and support.

“This did not meet the requirements of the Mental Capacity Act 2005.

“As a result of a coroner’s inquest held in September 2012 the provider had removed Advanced Care Plans (ACP) for nine people who lived at the service whilst legal advice was being sought about these. As a result, people’s rights were not protected if their illness progressed, as their choices and wishes were not known.

“Therefore their wishes could not be acted upon with regard to end of life care whilst living at the service, or if they moved between different services. People were cared for by staff who were not supported to deliver care and treatment safely, and to an appropriate standard and in line with the provider’s own policy.

This included staff not receiving regular, formal supervision or training in areas including advanced care planning, consent or Do Not Attempt Resuscitation (DNAR).

“The provider had a system to regularly assess and monitor the quality of service that people received, however the lack of linking risk management and quality improvement, and a culture of being reactive meant people were at risk at the service.”

A spokesperson for the home said: “Since the Care Quality Commission inspected the home last November we have been working closely with our GPs and all the appropriate authorities, to gain full compliance.

“The health and wellbeing of our residents is our absolute priority and we have implemented a range of measures to address these concerns.

“We have reviewed our care plans with residents, their families and their carers, carried out a comprehensive review of staff supervision and strengthened our quality monitoring.

“We look forward to demonstrating to the CQC our full compliance when they next visit the home.”