Archived: Riddlesden Rest & Convalescent Home

Riddlesden Rest and Convalescent Home is situated on the outskirts of Keighley providing care without nursing to a maximum of ten people in single rooms. The home is a single storey adapted building. There is car parking to the front of the building and good wheelchair access. The home does not have any gardens but there is a patio area for people to use.

A registered manager was not required as the home was run by the registered provider. 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 the last inspection on 25 August 2016 the service was rated Inadequate and in Special Measures. We asked the provider to take action to make improvements in a number of areas and this action had been completed.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. However the manager was aware they still had to improve on some areas identified on the day of inspection and show they can sustain the improvements made. For these reasons the service has been rated as Requires Improvement.

People using the service told us they felt safe and well cared for. They expressed a high level of satisfaction with the service provided and of the staff that supported them. They considered there were enough staff to support them when they needed any help.

The manager followed a robust recruitment procedure to ensure all new staff were suitable to work with vulnerable people.

The staff we spoke with knew how to recognise signs of abuse and were clear about their duty of care to report any concern they may have. They had been trained in safeguarding people and had policies and procedures regarding this.

Arrangements were in place to make sure staff were trained and supervised. Staff felt confident in their roles because they were well trained and very well supported by the manager. People using the service had confidence in the skill and knowledge of staff who cared for them.

Medicines were mostly managed safely and people had their medicines when they needed them. Staff administering medicines had been trained to do this safely.

Risks to people's health and safety had been identified, assessed and managed safely.

We found the premises to be clean and hygienic and appropriately maintained. Regular health and safety checks were completed on the environment and on equipment used within the service. Fire safety was managed well and people had a personal evacuation plan staff were familiar with.

Staff were motivated and expressed their commitment to provide a high quality of care. Staff understood the importance of gaining consent from people and the principles of best interest decisions.

The home provided a well maintained, pleasant and homely environment for people who had created their own ‘home from home’ with personal possessions they had brought with them. People told us they were very satisfied with the accommodation and facilities provided.

People were provided with a nutritionally balanced diet that provided them with sufficient food and drink that catered for their dietary needs. Fresh produce was used and meals were homemade. People told us they enjoyed their meals.

People's care and support was kept under review, and people were given additional support when they required this. Referrals had been made to the relevant health and social care professionals for advice and support when people's needs changed.

People using the service had an individual care plan that was sufficiently detailed to ensure people were at the centre of their care. Care files contained a profile of people's needs that set out what was important to each person.

We found staff were respectful to people, attentive to their needs and treated people with kindness and respect in their day to day care. Care plans were written with sensitivity to reflect and to ensure basic rights such as dignity, privacy, choice and rights were considered at all times.

People had their dignity respected most of the time. We found one example where we felt the service could do more to support the dignity of a person.

Activities were varied and appropriate to individual needs and people were supported to live full and active lives as possible.

People using the service and visitors told us they were confident to raise any issue of concern with the registered manager and that it would be taken seriously and the right action taken.

People using the service, relatives, health care professionals and staff considered the management of the service was very good and they had confidence in the manager. Results of quality monitoring surveys completed showed a high satisfaction with the service, the facilities, the staff and manager.

There were systems in place to monitor the quality of the service to ensure people received a good service that supported their health, welfare and well-being. We found regular quality audits and checks were completed to ensure any improvements needed within the service were recognised and the right action to take was planned for.

We last inspected Riddlesden Rest and Convalescent Home in January 2014. At that inspection we found the service was meeting all the legal requirements in force at the time.

Riddlesden Rest and Convalescent Home provides personal care to a maximum of 10 older people, including people who live with dementia or dementia related conditions. Nursing care is not provided.

A registered manager was not required as the home was run by the registered provider. 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 said they felt safe and they could speak to staff as they were approachable. However, there were not enough staff on duty to provide safe and individual care to people. People said staff were kind and caring. However, we saw staff did not always interact and talk with people. There was an emphasis on supervision and task centred care. People were not always protected as when new staff were appointed robust recruitment processes were not used. Staff had received training about safeguarding and knew how to respond to any allegation of abuse.

Systems were not in place to ensure the health and nutritional needs of people were well-managed. People had access to health care professionals to make sure they received appropriate care and treatment. The advice and guidance given by professionals was not always followed to make sure people received the care they needed. We had concerns about some aspects of medicines management.

Regular staff knew people’s care and support needs. However, care records we looked at were not all up-to-date. Risk assessments did not accurately identify current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Records did not accurately reflect people’s current care and support needs to keep people safe and to ensure all staff were aware of their current individual care and support needs. Detailed individual information was not in place to help staff provide care to people in the way they wanted. People's privacy and dignity were not always respected.

Staff received some opportunities for training to meet peoples' care needs. Induction training was not carried out with staff new to the service to ensure they met people’s needs in safe way. A system was in place for staff to receive supervision and appraisal but staff supervision records were not available.

Staff did not have a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People were offered limited choices about aspects of their daily lives. There were limited activities and entertainment provided for people to remain stimulated.

The registered provider told us the home had a quality assurance programme to check the quality of care provided. However, there were no records available to evidence this. The systems used to assess the quality of the service had not identified the issues that we found during the inspection to ensure people received safe and effective care that met their needs. A complaints procedure was available although it required updating. People told us they would feel confident to speak to staff about any concerns if they needed to. Not all areas of the home were clean and well maintained for the comfort of people who used the service.

The overall rating for this service is inadequate and the service is therefore in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measure will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People who used the service told us they enjoyed living at the home and were complementary about the care provided by staff. One person said "I am well looked after and have no concerns about the service or staff. Another said 'I am happy living here and enjoy the company."

People were complimentary about the meals and said they had more than enough to eat. They told us they were able to make suggestions and requests about changes to the menu and f they didn't like what was on the menu they were able to ask for something different to be prepared.

We spoke with two visitors and they told us they were pleased with the standard of care and facilities provided by the service. One person told they had always been satisfied with the care provided and were always made to feel welcome when they visited. Another person said 'Because the home is small my relatives settled very quickly, which I don't think would have happened if they had moved into a larger residential home.'

We spoke with one visiting healthcare professional who told us they had no concerns about the standard of care provided at the home and staff always followed their advice and guidance.

We spoke with people using the service and they told us that they were happy with the care at Riddlesden Rest and Convalescent Home.