Archived: Ravensmere Rest Home

Ravensmere Rest Home is a residential care home providing personal care to 9 at the time of the

inspection. The service can support up to 24 people living with dementia, mental health conditions and learning disability.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support:

The provider failed to have safe and robust systems in place when incidents and accidents occurred, and these were not reported which placed people at serious risk of harm.

Risk management was poor. Staff were not provided with enough clear guidance to

support people safely.

There were limited opportunities for choice, control and independence. There was no activity schedule or plan and opportunities to access the community or to pursue individual interests or hobbies.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Where people lacked capacity to make decisions, the provider failed to put in place documents to support decision making.

Right Care:

Care was not always person-centred or designed to promote people's dignity, privacy and human rights.

Staff did not always understand how to protect people from poor care and abuse. The provider often delayed or cancelled visits from other agencies.

Not all staff were appropriately skilled to meet people’s needs and keep them safe.

Right Culture:

People were supported by staff who did not understand best practice in relation to people with a learning disability and/or autistic people.

There were indicators of a closed culture. Staff did not ensure risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity. The routines within the service were not always personalised to individual people.

The provider failed to develop effective governance and quality assurance system to assess the quality and safety of the support people received. The provider failed to acknowledge the concerns consistently identified during inspections which meant improvements were not made to improve the care people received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update the last rating for this service was inadequate (published 23 December 2021). At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended the provider reviews best practice guidance on creating a supportive environment for people living with dementia. At this inspection we found the provider had not acted on this recommendation or made any improvements.

Why we inspected

The inspection was prompted in part due to a safeguarding and continued concerns received about people living at Ravensmere Rest Home not having access to professionals and stakeholders involved in their care. The provider was continuing to not allow professionals and stakeholders to access the service to carry out their statutory obligations to ensure people’s safety and wellbeing. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, safeguarding, mental capacity, staff training and person-centred care.

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

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

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

People’s experience of using this service and what we found

We received information from the local authority raising concerns about staffing levels at the service. We visited the service to check that there was enough staff to meet people’s needs.

Staffing levels were appropriate to meet people’s needs.

Whilst we had recently looked at infection control processes in the service, we found the service remained clean.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was inadequate (published 23 December 2021).

The service remains in special measures.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

We undertook this targeted inspection to check on a specific concern we had about staffing levels. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

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

We found the following examples of good practice.

Staff were provided with adequate supplies of personal protective equipment (PPE) and were seen to be wearing this appropriately.

At this inspection the provider was enabling relatives to visit their family members.

Staff had received additional training in infection prevention and control

Ravensmere Rest Home is a residential care home providing personal care to 13 people at the time of the inspection. The service can support up to 24 people living with dementia and mental health conditions.

People’s experience of using this service and what we found

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider failed to engage appropriately with people, their representatives or their funding authorities when making decisions about change of accommodation. There was no record of the planning required to identify if any risks associated with these moves had been identified or mitigated to ensure people were safe.

There have been significant concerns about the quality and safety of the service, which had not been identified or addressed by the registered provider. Accidents and incidents were not effectively reported, recorded and responded to. This placed people at increased risk of harm.

People's needs were not robustly assessed on admission and people's care and support needs were not managed safely or regularly reviewed. Care plans and risk assessments did not always reflect people's needs, risks or provide up-to-date information to guide staff on how to safely support them. This placed people at significant risk of harm. Staff training information was not always kept up to date, we have made a recommendation about training.

We were not assured the provider always followed current guidance on the testing of people being admitted to the service for COVID-19. Some improvements were needed to the environment; we have made a recommendation about supportive environments for people living with dementia.

The service was not well-led. There were continued significant concerns about the quality and safety of the service. The provider had failed to take sufficient and timely action to address safety issues and to make improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update) The last rating for this service was requires improvement (published 15 September 2021).

The provider completed an action plan after the last inspection; however, the action plan was not completed within the agreed timescales and did not include specific timescales in relation to when they would improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This inspection was prompted in part due to concerns received about people moving to Ravensmere Rest Home from the providers other care homes without establishing that appropriate consultation with people, their representatives or people’s funding authorities was undertaken. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The service is therefore rated inadequate. This service has been rated requires improvement or inadequate overall for the last five consecutive inspections.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to management of risk, safeguarding processes, consent and governance arrangements at this inspection.

Please see the action we have told the provider to take at the end of this report.

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

Follow up

The overall rating for this service is Inadequate and the service remains in 'special measures' as one of the key questions remains inadequate.

This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect to check for significant improvements.

If the provider has not made enough improvement and there is a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

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

Ravensmere Rest Home is a residential care home providing personal care to nine people at the time of the inspection. The service can support up to 24 people living with dementia and mental health conditions.

People’s experience of using this service and what we found

We found two incidents which resulted in harm had not been escalated to safeguarding for investigation. The provider had failed to submit notification to the CQC in relation to these incidents in line with regulation and duty of candour.

The provider was introducing new audit tools to be used at the service covering the environment and people’s care. We found these tools had not identified the issues we highlighted on inspection.

Improvements had been made to the management of medicines and people received their medicines safely. Care plans were in the process of being reviewed to reflect peoples care needs.

The provider had addressed issues within the environment to make these safe for people living there.

We observed there were enough staff on duty to meet people’s needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update: The last rating for this service was inadequate (published 11 June 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do. At this inspection some improvements had been made but the provider was still in breach of regulations. This service has now been rated requires improvement or below for the last five inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has improved to requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We found the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ravensmere Rest Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified two continued breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014: regulations 13 (safeguarding service users from abuse and improper treatment), 17 (good governance). Action we told the provider to take (refer to end of full report).

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

Follow up

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

Special Measures

The overall rating for this service is requires improvement and the service remains in 'special measures' as one of the key questions remains inadequate. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect to check for significant improvements.

If the provider has not made enough improvement and there is a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

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

Ravensmere Rest Home is a residential care home providing personal care to 14 at the time of the inspection. The service can support up to 24 people living with dementia and mental health conditions.

People’s experience of using this service and what we found

We requested a range of information from the provider, but this was not received. Three incidents within the service which had resulted in harm had not been adequately managed or escalated in line with safeguarding and duty of candour processes. We shared this with the safeguarding team. The provider had failed to submit notifications of these incidents to CQC, which they are required to do.

People continued to be at risk of harm as the registered manager and provider had not assessed and mitigated risks to people. This included risks in the environment of the service as well as risks associated with people's health and care needs. A risk was identified in relation to fire safety records. We requested a visit by the Fire and Rescue Service.

There were enough staff available to meet people’s needs. However, we were not assured all staff had been recruited safely.

Medicines were not consistently managed safely. We were not reassured people had received their medicines as prescribed.

The providers monitoring and assurance systems and processes had not identified the issues found during the inspection and lessons had not been learned from previous inspections.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update: The last rating for this service was requires improvement (published 06 December 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to staffing, safeguarding concerns, infection control and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We found the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ravensmere on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014: regulations 12 (safe care and treatment), 13(safeguarding service users from abuse and improper treatment), 17 (good governance). Action we told the provider to take (refer to end of full report).

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

Follow up

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

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

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

Ravensmere Rest Home is a residential care home providing personal care to 18 people at the time of the inspection. The service can support up to 24 people living with dementia and mental health conditions. The care home is one adapted building, set over three floors with a courtyard garden accessible from the communal lounge.

This was a comprehensive inspection to identify if the improvements seen at the last inspection on 3 June 2019 had been maintained, and if improvements to the service had continued.

People’s experience of using this service:

Staff spoken with did not always recognise abuse or follow safeguarding procedures. Management however, were aware of the process and had followed procedures before when concerns were raised.

Risk assessments were undertaken but these were not comprehensive or consistently followed by staff.

There were sufficient numbers of staff, however the ability of staff to communicate effectively impacted on the delivery of care. We found that staff were not always recruited in a safe way.

People using the service and their relatives we spoke with, told us they felt safe and were happy with the care provided. They said the registered manager was approachable and they were confident that any concerns raised would be dealt with appropriately.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Audit monitoring by management was in the process of being introduced at the last inspection, to provide a closer oversight of the service. Some audits were in place, although we found these not to be robust enough as they did not highlight issues we found. The audit design was being trialled, and the director told us they were reviewing the layout to make the auditing procedure more effective.

We saw that actions taken in relation to fire safety that were noted on the previous inspection, were maintained. Infection control practices at the last inspection had improved, however, we found incidents of poor infection control procedures during our visit.

We saw that refurbishment had begun with new flooring in the front entrance. The plan shown to us included reviewing the communal areas and bedrooms to ascertain where refurbishment was required.

New person-centred care plans were being introduced and those completed were comprehensive and clearly outlined guidance to staff on how to meet people’s needs. However, staff did not always follow the guidance and we saw examples of poor moving and handling practices.

People were supported to eat and drink and alternative diets were catered for. Referrals to health and social care professionals were made as needed.

Activities were limited at the last inspection and recommendations were made to review activities to meet people’s needs. This had not improved.

Rating at last inspection:

On 17 December 2018, a scheduled comprehensive inspection was undertaken and looked at all key questions. The report was published on 7 February 2019 and the service was rated inadequate and placed in special measures. We returned on 3 June 2019, and improvements had been made around safe and well-led. The report was published on 18 July 2019 and the service was rated requires improvement and they were in breach of Regulation 17 Health and Social Care Act (Regulated Activities) Regulations 2014, Good Governance.

At this inspection, enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement: We identified four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014: regulations 12 (safe care and treatment), 13(safeguarding service users from abuse and improper treatment), 17 (good governance) and 19 (fit and proper persons employed). Action we told the provider to take (refer to end of full report).

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme for services that Require Improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

At our last inspection on 17 December 2018 the service was rated as inadequate and placed in special measures. This was a comprehensive inspection to see if improvements had been made.

People’s experience of using the service: One person said, “I don’t know what I'd do without them here, I can look after myself, but I feel safer being here rather than at home.”

Fire safety and infection control practices had improved. Overall the environment still needed updating and refurbishment. The director told us they had plans to build on the work they had already started with regards to further improvement of the environment for people.

New systems were being implemented for the monitoring of the service and to give the provider better oversight. The director was in the process of Implementing new governance systems to allow for closer monitoring at the service.

There were limited activities at the service. We recommend the registered manager reviews activities on offer and matches these with the needs of the people living at the service, while considering some people would benefit from one to one activity.

Staff understood their responsibilities to safeguard people from the risk of harm. There were systems in place to ensure the safe management of medicines. Staff had the appropriate training.

The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were supported to eat and drink enough to ensure they maintained a balanced diet and referrals to other health professionals were made when required.

People were supported by caring and compassionate staff who supported people with patience. People's right to privacy was up held and their independence was promoted.

The manager responded to complaints received in a timely manner. Support was given to people at the end of their life.

Rating at last inspection: Inadequate (7 February 2019)

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: We identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to good governance: Action we told provider to take (refer to end of full report)

Follow up: We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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, 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.

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

People were at risk of harm as fire safety procedures and checks were not effective and the maintenance of fire doors did not keep people safe from the risks of fire.

People were at risk as the infection prevention and control systems were not effective and did not reflect best practice.

Staff members did not always follow safe practice when supporting people with their medicines.

People’s individual preferences were not prompted when supporting them with meals and food options.

The physical environment did not contain appropriate signage to help people orientate themselves to their surroundings.

People’s individual protected characteristics were not clearly identified.

People’s privacy was not always respected.

People’s individual communication needs had not been assessed in line with best practice.

The provider did not have effective systems in place to monitor the quality of the service they provided or to drive improvements where needed.

People had care and support plans which gave staff members the information that they needed to provide care but staff members did not routinely read them.

People felt that the activities that were available were limited and that at times they felt unstimulated.

People did not always receive timely support when showing signs of anxiety or distressed.

Staff members had access to training and felt supported in their role. New staff members completed a structured introduction to their role.

People were referred to additional healthcare services when it was required.

The provider had systems in place to respond to complaints or compliments from people or visitors.

Rating at last inspection: Good (Last report published 17 September 2016). Following significant concerns regarding people’s safety the current rating is ‘inadequate’ overall.

About the service:

Ravensmere Rest Home is registered to provide accommodation and personal care for up to a maximum of 24 people who have a diagnosed mental health condition or who may be living with dementia. Ravensmere does not provide nursing care. At this inspection 18 people were living there.

Why we inspected:

This was a planned inspection based on the rating at the last inspection, ‘Good.’

Enforcement.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded

Follow up:

We will monitor Ravensmere Rest Home and re-inspect as part of our published inspection programme timetable. In addition, we will receive regular updates from the provider on the progress they are making in addressing the concerns we have raised with them.

Ravensmere Rest Home provides accommodation and personal care without nursing for up to 22 persons some of whom may be living with dementia. At the time of our inspection 22 people were living at the service.

The service had a registered manager. 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.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager had made appropriate DoLS referrals.

People had sufficient amounts to eat and drink to ensure that their dietary and nutrition needs were met. The service worked well with other professionals to ensure that people's health needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including a doctor, community psychiatric nurse and dementia nurse specialist.

Staff were attentive to people's needs. Staff were able to demonstrate that they knew people well. Staff treated people with dignity and respect.

People were provided with the opportunity to participate in activities which interested them. These activities were diverse to meet people’s social needs. People knew how to make a complaint; complaints had been resolved efficiently and quickly.

The service had a number of ways of gathering people’s views including talking with people, staff, and relatives. The registered manager carried out a number of quality monitoring audits to help ensure the service was running effectively and to make improvements.

Some of the people who lived at Ravensmere Rest Home had complex needs but some were able to speak with us. We spoke with five of the 23 people who used the service on the day of our inspection. We gathered evidence of people's experiences of the service by observing how they spent their time and we noted how they interacted with other people who lived in the home and with staff. We also spoke with four staff members, the manager and provider and two relatives. We looked at five people's care records. Other records viewed included staff recruitment and training records, staff rotas, health and safety checks, medication records and satisfaction questionnaires completed by the people who used the service, their relatives and staff.

We considered our inspection findings to answer questions we always ask; Is

the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service we were asked for our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns.

We saw that appropriate processes were in place with regard to medication and its administration, so that people could be confident they were protected from the unsafe use and management of medicines.

Appropriate checks were undertaken before staff began employment at Ravensmere Rest Home.

The service was safe. We saw records which showed that the health and safety in the service was regularly checked and that staff records and other records relevant to the management of the service were accurate and fit for purpose.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said: "The staff are very polite and friendly.' Additionally two relatives said: 'We have complete peace of mind and no concerns whatsoever.'

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information.

We found that there were enough trained, skilled and experienced staff to meet people's needs. Staff received the training they needed to provide care and support safely and were able to demonstrate that they understood the specific needs of the people who used the service and how those needs were to be met.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, and respectful manner. We saw that staff treated people with respect. One person who commented on a recent quality survey questionnaire said: 'I love the staff's calm approach when caring for the residents. Nothing is too much trouble and any problems are quickly dealt with in a calm and caring way.'

Staff had a good knowledge and understanding of people's care and support needs, including recognising and supporting them as an individual. Where people required assistance, staff provided this in a timely manner and at a relaxed pace. This ensured people received care and support consistently and in ways that they preferred.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

People's choices were taken in to account and listened to.

People who used the service were generally provided with the opportunity to participate in activities which interested them. Two people who commented on a recent quality survey questionnaire said they would welcome the opportunity to have a more structured activity programme.

People told us that they knew how to make a complaint if they were unhappy. We saw that where people had raised concerns appropriate action had been taken to address them. People can therefore be assured that complaints are investigated and action is taken as necessary.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good service at all times.

The service had a quality assurance system which was to be further developed, and records seen by us showed that identified shortfalls were addressed promptly.