Archived: Ravenswood

Ravenswood is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ravenswood provides accommodation and personal care for up to 36 older people, some of whom are living with dementia. At the time of our inspection, the service was providing accommodation and personal care to 28 people.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are registered persons. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they were safe and happy living at Ravenswood. Relatives told us they felt their relatives received good care from staff who were competent and caring. Throughout our inspection we observed positive interactions between people living at the service and care staff. Staff spoke kindly to people and responded quickly to care needs. Staff knew people well and were able to describe their needs and preferences.

Medicines were managed safely and people received them at the appropriate times.

People were positive about the food and told us they enjoyed their meals. The dining room was busy and noisy during meal times but people could choose to eat in their rooms. Staff supported people to eat independently or assisted if needed. Staff checked that people had enough to eat and drink.

The environment had been adapted where possible to the needs of people living with dementia and people with compromised mobility. People had a choice of two lounges and there was lift access to all floors of the home.

The service provided a range of activities. Some of these took place outside of the service, such as trips to the garden centre or out for coffee. Some people chose not to participate in these activities and preferred to spend most of their time in their room.

People received person-centred care, however this was not always reflected in care plans. Some people’s plans lacked information about how staff should support them if they became distressed. Staff did not always record capacity and best interests decisions in a clear manner.

The provider had a comprehensive governance system which was operated effectively. Shortfalls in the service were mostly identified and rectified. However, the audits for care plans and best interests decisions had not picked up these shortfalls.

We carried out a comprehensive inspection of Ravenswood on 31 July and 1 August 2017. Following this inspection, we served a Warning Notice for a breach of regulation 17 of the Health and Social Care Act 2008. This was because the provider did not have fully effective systems and processes for identifying and assessing risks to the health, safety and welfare of people who use the service. This was because people who used the service were not protected from the proper and safe management of medicines and their rights were not consistently upheld in line with the Mental Capacity Act 2005.

We undertook a focused inspection on 22 March 2018 to check the provider was meeting the legal requirements in regards to one of the regulations they had breached, and check they had complied with the Warning Notice. This focused inspection looked at the breach of regulation 17. This report only covers our findings in relation to this area. You can read the report from our last comprehensive by selecting the, 'All reports' link for ‘Ravenswood’ on our website at www.cqc.org.uk

Ravenswood provides accommodation and personal care for up to 36 older people, some of whom are living with dementia. At the time of our inspection, the service was providing accommodation and personal care to 28 people.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are registered persons. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection, we found the provider had taken action to comply with the warning notice.

At our previous inspection, the provider did not have fully effective systems and processes for identifying and assessing risks to the health, safety and welfare of people who use the service. At this inspection we found that their auditing processes had improved.

At our previous inspection, we found that the provider did not consistently provide safe care and treatment. At this inspection, we found improvements had been made this area of their work. Medicines were managed safely and where risks had been identified, care plans consistently detailed the steps staff should take in order to keep people safe.

At our previous inspection, people's rights were not consistently upheld in line with the Mental Capacity Act (MCA) 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. At this inspection improvements had been made. We found consent to care was now sought in line with legislation.

At the previous inspection, people’s care plans were not person centred or sufficiently detailed and electronic versions of the care plans were not as detailed as the written ones. At this inspection, care plans we saw were person centred and provided clear and detailed guidance for staff on how to meet people's needs. Electronic plans were also in place and now provided the same level of detail.

You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Ravenswood, on our website at www.cqc.org.uk

Ravenswood is registered to provide accommodation for people who require nursing or personal care for up to 36 people. At the time of our inspection there were 30 people living at the service.

A registered manager was in post at the time of inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our previous inspection we found that the provider did not consistently provide safe care and treatment. At this inspection we found some improvements had been made this area of their work requires further development. Medicines were not consistently managed safely. Where risks had been identified, care plans did not consistently detail the steps staff should take in order to keep people safe .

At our previous inspection people's rights were not consistently upheld in line with the Mental Capacity Act (MCA) 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. At this inspection some improvements had been made but this area of their work still requires further development. Consent to care was not consistently sought in line with legislation.

At our previous inspection the provider did not have fully effective systems and processes for identifying and assessing risks to the health, safety and welfare of people who use the service. At this inspection we found that their auditing processes had not identified the shortfalls found at this inspection.

The provider was not consistently responsive to people’s needs. Although the old care plans we saw were person centred and provided clear and detailed guidance for staff on how to meet people’s needs, the electronic plans in place did not provide the same level of detail. The electronic plans were not person centred and did not provide enough information for staff. At times the plans provided conflicting information.

At our previous inspection we identified that there were insufficient infection control measures in place. At this inspection we found sufficient improvements had been made.

Records showed that a range of checks had been carried out on staff to determine their suitability for work. Staffing rotas demonstrated that staffing levels were maintained in accordance with the assessed dependency needs of the people who used the service.

New staff undertook an induction and mandatory training programme before starting to care for people on their own. Staff were supported through a regular supervision programme. Supervision is where staff meet one to one with their line manager.

People’s nutrition and hydration needs were effectively managed. People had access to on-going health care services.

We observed a number of positive interactions between staff and people using the service. Staff knew people well and there was a friendly and relaxed atmosphere throughout the service. We observed staff laughing and joking with people. Staff were attentive and ensured people engaged in things they enjoyed.

Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them.

The registered manager was well-respected by staff, people and their relatives. People were encouraged to provide feedback on their experience of the service and actions were taken, where appropriate.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

At our last inspection in December 2014 we identified concerns relating to staff being unable to explain the principles of the Mental Capacity Act (MCA) or able to explain reasons for assessing people’s capacity. During this inspection we found some improvements had been made although the principles of the MCA were not being followed.

Ravenswood provides care for older people with nursing and personal care needs. At the time of the inspection there were 31 people living at the home. Accommodation is arranged over three floors. It has two lounges, a dining area, two snug areas with couches, a conservatory and top floor offices. There is a drive way, a front landscaped garden, summerhouse and back garden.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are registered persons. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was present during the inspection.

People could be at risk of cross infections due to poor hand washing facilities, specialist medical equipment not being clean or ready for its next use, and staff wearing jewellery and false nails that could impede effective hand washing. Where people were unable to make decisions relating to their care and treatment the principles of the Mental Capacity Act were not always being followed.

People’s care plans did not always contain detailed, accurate and informative risk assessments in relation to their individual needs. People felt safe in the home and received their medicines safely and when required by staff who had received training. People were supported by staff who felt happy and supported by the management of the home.

People were supported by staff who had appropriate checks in place prior to commencing their employment. People were supported by adequate staffing levels and staff supported people in a kind and caring manner. Staff received regular supervision and training to ensure they were competent and skilled to meet people’s individual care needs. People were happy with the meals and had various choices each meal time.

People were supported to maintain relationships with friends and family and there were regular activities within the home. People were supported by staff who gave people choice and control in their care and support.

People felt able to make a complaint to the registered manager should they need to do so. People and relatives were involved in planning their care.

The quality assurance systems were not always identifying areas for improvement.

There was a system in place to ensure people, relatives and professionals views were sought so that improvements could be identified.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Care planning and assessment processes were comprehensive. Specialist involvement had been sought where required which meant that specific care needs could be met effectively. Risk assessments were in place to alleviate and respond to risks which could affect people's health and welfare. A range of activities were available to people suited to the needs of people living in the home.

People told us they felt safe. One person told us, "staff are all very kind, they look after me". Staff had completed safeguarding training. They demonstrated a good knowledge of the nature of abuse and how to respond to any concerns about possible abuse.

The changes in manager had impacted on staff morale. Recently this had improved and staff were feeling supported with improved opportunities to discuss their role and responsibilities through staff and one to one meetings. Staff told us they had received training in supporting and caring for people living with dementia.

We found that the provider had addressed the need for improvements in their auditing and quality assurance practices.

Many of the people who lived at Ravenswood were unable to express their views verbally. However we did speak to five people who lived in the home and we observed staff interactions with people throughout the day.

People spoken with told us they felt staff members were good, one person said, 'They are all nice and very kind.' Another person told us, 'They have changed my room, I've got a new TV and I like my pictures.' One person told us they did not feel as involved in decisions as they would like, but they did say if they wanted to go to their room they only had to ask. This person also told us they didn't feel there were enough activities to keep them occupied through the day. We noted that the activities person was not working the day of our inspection.

We saw that staff interactions were friendly, caring and respectful. We noted a friendly but appropriate banter between staff and people who lived in the home.

We found that improvements had been made at Ravenswood. Care plans had been re-written, staffing levels reviewed and staff training put in place. We saw that a new system was in place to ensure that quality auditing was carried out to assess the quality of service provided.