11 May 2015
During an inspection looking at part of the service
This inspection took place 11 May 2015 and was unannounced. We carried out the inspection because concerns had been raised through a safeguarding alert about staffing at the home. We also checked on progress the provider had made in relation to action plans they had sent us following our inspection in January 2015, when we found continued breaches of regulations and had found the service inadequate. This inspection was to assess how the provider had responded to our concerns.
Ravensmount Residential Care Home is registered to provide accommodation for up to 30 people. At the time of the inspection there were nine people using the service, some of whom were living with dementia.
The home has not had a manager registered since May 2014. 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.
We found there were continuing breaches of regulations in relation to the maintenance of the premises and the cleanliness of the home. Gas supplies to the home’s kitchens had been disconnected in January 2015 due to concerns over the safety of the system. A key pad lock remained broken affecting the security of the building and allowing unmonitored access to the home. One unused room remained unsecured and had no handle on the inside of the door, meaning people could inadvertently become trapped in the room. Window restrictors had been fitted to some windows, although the devices used did not meet the requirements for care homes as set out by the Health and Safety Executive. Other windows still had door chains fitted as restrictors, although fittings had been moved to make them more difficult to open. Some fire doors were broken meaning they did not shut into the recess of the door frame correctly to make a smoke tight seal. Some work had been undertaken as to the maintenance of the outside of the building with some ground floor windows painted.
The home was superficially clean, although some bedrooms had dust and crumbs in them. Domestic staff told us they had returned to splitting their working hours between cleaning tasks and working in the kitchen. This meant the time dedicated to cleaning at the home had reduced to 31 hours per week. They told us that with the current hours they found it difficult to deep clean individual rooms. The provider told us he had changed the rota system for domestic and kitchen staff to ensure staff were available from 8.00am until 6.00pm.
We noted an infection control audit had been untaken in January 2015. However, this was largely tick box and where there were items ticked as not being in place, there was no indication what action had been taken. The provider told us they had met with the commissioners and infection control staff and had agreed an action plan. He said he would forward this plan to us.
We found the majority of lifting equipment had been checked and safety certificates were now in place. Weighing scales had been omitted from these checks and the provider told us this had been an oversight. People said there were enough staff at the home and we observed there was a good ratio of staff to people living at the home. We checked staffing rotas and saw there was generally three staff on day shifts and two at night. The provider agreed that cover by senior care staff had been an issue in recent months but was being managed, including the use of agency staff.
Staff told us they had undertaken some training in the months since the previous inspection, although senior staff told us they had not received any formal training on the safe handling of medicines since 2011.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The provider told us that all people living at the home had now been assessed in relation to whether they had their freedom restricted, as defined by the Mental Capacity Act (2005) and the DoLS guidance. We checked with the local authority safeguarding adults team, who confirmed reviews were in progress.
We found care records had not been reviewed or updated since February 2015 and in some cases there were two sets of care plans in place for each element of people’s care; meaning it was not clear what action should be taken to support people. We found one person’s diabetic medicine’s had been changed but this had not been updated in their care plan.
We found there were continuing breaches of regulations in relation to quality monitoring at the home. Quality monitoring documents remained limited in their content and did not contain any action plans or dates for work to be completed by. The provider showed us a document concerning ‘walk round’ audits of the home which merely stated the home was clean and tidy. The audits process had failed to note the broken lock and fire risks highlighted during the inspection. Audits of care plans were also not recorded as taking place since February 2015. Some review of incidents and accidents had been undertaken, but this was limited.
We had previously found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. At this inspection we found continuing concerns which constituted a breach of three regulations under the new Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which came into force on the 1 April 2015. These related to safe care and treatment, good governance and staffing.
We have judged that the continued breach of regulations by the provider has had or may have a major impact on people. We have taken enforcement action against the provider and have issued a Notice of Decision to confirm the removal of the location Ravensmount Residential Care Home from their registration.