Archived: Ranyard at Mulberry House

Is the service safe?

We looked at 11 care records and saw that the service had some plans in place to manage risks to people's health. For example, there was guidance for staff on how to support people who were at risk of developing pressure ulcers. However, staff had not always implemented these plans. We found that staff did not always protect people from risks identified from an assessment. We observed two people were not supported with regular repositioning.

We found there were people needed a specialist diet to meet their health needs, this was not always provided. We saw people needed to use equipment such as a hoist, there were no maintenance records, slings were frayed and torn in places and the handle bar cover on a standing hoist was torn exposing metal. This increased the likelihood of injury to people.

People were at risk of receiving unsafe care because risk management plans were not always put into action. Care records and assessments were not always updated to reflect people's current care needs. This increased the likelihood of deterioration in people's health.

Procedures for dealing with emergencies were in place and staff were able to describe these to us. However, we found three fire extinguishers available to staff had expired, in 1991,1997 and 2007.

The provider and staff did not always understand their responsibilities under the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). The Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS), supports people a framework to support people who are unable t make decisions for themselves. We asked for the assessments completed to establish a person's mental capacity. We requested the subsequent application for Deprivation of Liberty Safeguards (DoLS), this was unavailable at the time of writing this report.

Is the service effective?

People had an assessment of their needs before admission to the home and before receiving care and support. From this information, individual care plans and an assessment of risk were developed. Assessments included needs for equipment, mobility aids and specialist dietary requirements. Care plans identified areas of risk and a management plan was developed to minimise them. However, we found that staff did not always implement care plans or support people to reduce the risks identified.

Is the service caring?

People told us that staff were kind, supportive and staff were aware of their individual needs and preferences. One person told us, 'They [the staff] do their best.'

Is the service responsive?

We saw that the provider did not make arrangements for further assessments or support for people when required. For example where people had lost weight unintentionally, referrals had not been made to health professionals to meet their changing care needs.

Where it was identified that people required encouragement with eating and drinking, this did not happen. People's care records were not regularly updated to reflect what people ate and drank during the day.

Is the service well led?

People told us they felt able to raise and discuss concerns with staff or the manager as appropriate. However, some staff told us they were unsupported and not listened to by the provider and the manager of the service. They told us the manager and senior managers were unresponsive to any requests, particularly relating to errors in their monthly salaries. Regular staff team meetings, with care workers, nurses, administration and domestic staff did not take place.

Staff received some training and new staff completed their induction. We were unable to establish whether all mandatory training was up to date, as the training records provided to us were unclear.

Staff did not always receive regular supervision or an appraisal. Staff we spoke with and staff records we looked at confirmed this.

On this inspection we found the home had taken action to address the shortfalls in the service. People's needs were assessed and care was planned and delivered in a way that was intended to ensure people's safety and welfare. Staff understood and were aware of the guidance on the correct use of bed rails and the need for a risk assessment and agreement necessary to use these safely. On care records we looked at we saw that a risk assessment was carried out before bed rails were used, this included an assessment of capacity as well as consent for their use.

People using the service found the home offered them a comfortable and friendly environment, a person spoken with said, "the atmosphere is warm and supportive and the care is good".

A person that has used the service for many years told of the respect shown by staff, they said, "I cannot fault the staff team here, they are polite and respectful and are eager to please us, they do the right thing and it is a difficult task to please us all".

The facilities provided helped ensure people had their privacy promoted, everyone had their own spacious single room with en suite facilities.

A relative spoke of the confidence they had in the service, they said, "when my partner came to live at the home I was anxious at first that I could not be around all the time. When I realised they were in safe hands it gave me confidence in the service, nothing is too much trouble for staff".

There were no concerns about the care and treatment delivered at the home but we found that for people using bed rails the service had not risk assessed the situation or the equipment needed to help individuals remain safe while in bed.