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The Rylands Nursing and Residential Home Requires improvement

Reports


Inspection carried out on 6 April 2018

During a routine inspection

The Rylands Nursing and Residential Home 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. It is registered to support up to 44 people. At the time of our inspection there were 38 people using the service.

At the last inspection in September 2016, the service was rated Good. At this inspection we found that the service was rated Requires Improvement overall. The key questions of ‘is the service safe?’ and ‘is the service well-led?’ were rated as Requires Improvement. Other key questions were rated as Good.

Sometimes there were not always enough staff. The registered manager was attempting to get more staff.

There was sometimes insufficient guidance about ‘as and when required’ medicines which meant people may not always receive their medicine at the right time.

We saw risks were assessed and planned for to keep people safe, but occasionally some plans were not always updated when people’s needs had changed.

Systems in place had not always identified some concerns.

People were protected from avoidable harm by suitably recruited staff who understood their responsibilities and could recognise the potential signs of abuse.

Infection control measures were in place and the building was being appropriately maintained and checked on to keep people safe.

People were supported by appropriately trained staff who were supported by the management team. We have recommended staff continue to receive updated training so all necessary training is up to date. People had access to suitable food and drinks and were given a choice. People also had access to other health professionals to help them remain healthy.

People were treated with dignity and respect, could make decisions about their support and were encouraged to remain independent where possible.

Staff knew people well and people had plans in place which included details of they liked to be supported. Activities were available for people to partake in, both on an organised group manner and also individually. There was a system in place to record and monitor complaints. The service had considered people’s end of life needs.

It was felt the registered manager was approachable and they were supported by the provider. People and staff were encouraged to offer feedback.

Inspection carried out on 15 September 2016

During a routine inspection

This inspection took place on 15 September 2016 and was unannounced. The Ryland’s is a residential and nursing home that provides personal care and accommodation, diagnostic and screening procedures and treatment of disease, disorder or injury for up to 42 older people some of whom are living with dementia, at the time of the inspection there were 32 people living at the service.

The service did not have a registered manager in post on the day of the inspection. The service had been without a registered manager for one month prior to the inspection. The provider told us the current manager would be making an application to be registered in the near future. 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 felt safe. People received support from staff that were knowledgeable about their responsibilities to identify and report any concerns related to the abuse of vulnerable adults. Care plans included risk assessments and where risks were identified management, plans were in place to minimise the risk. Peoples' medicines were managed safely. The provider had recruitment processes in place to ensure people were supported by staff that were suitable to work with vulnerable people. There was enough staff to meet people’s needs safely.

People received support from knowledgeable staff who had access to good support from the provider. Staff understood the Mental Capacity Act 2005(MCA) and supported people in line with the principles of the act. People enjoyed the food, could choose what to eat and had their dietary needs met. People received support to access health professionals to maintain and improve their health.

People had developed caring relationships with staff. People were asked for their views and could make choices about their care and support. People were encouraged to be independent. Staff treated people with dignity and respect and protected their privacy.

People had their needs assessed and care plans were in place which identified peoples individual needs and preferences. People could maintain their hobbies and had access to individual and group activities. People were able to make complaints and felt these would be dealt with effectively.

People were positive and complimentary about the management of the service. People felt involved in the service and were asked about their experiences. The provider looked for ways to improve the quality of the service people received and had effective monitoring systems in place.

Inspection carried out on 10 February 2014

During a routine inspection

We carried out this review to check on the care and welfare of people who lived at The Rylands Nursing and Residential Home. The visit was unannounced which meant the provider, manager and staff did not know we were coming.

We spoke with five people who lived at the home and two relatives. People who lived in the home and their relatives told us that they were asked about the care they or their relative needed. We saw that people received the care and assistance they needed. One person said: "I could not be better looked after".

We found the home was clean and there were appropriate arrangements in place to reduce the risk of cross infection. People who lived or visited the home all told us they found the home to be clean.

Appropriate arrangements were in place to store and manage people's medicines.

Staff received training and support to provide people with the care they needed. One relative told us: "I cannot fault them (the staff)". One person said: "The best night staff I have ever come across".

The home had appropriate systems in place to enable people to raise concerns and be

confident that their concerns would be investigated and addressed.

Inspection carried out on 7 January 2013

During a routine inspection

People told us that they liked living at the home. One person said, “You couldn’t find a better place”. Another told us, “I know it will get a good report”.

People told us that the staff, “Put themselves out for me”, that they were, “Very obliging” and, “A hard working lot”.

The staff told us that they enjoyed working at the home and that they received good support from the management.

We found that people were given lots of opportunities to express their views about the service they received and that their views were respected.

People told us that they felt safe in the home. We found that there was a comprehensive safeguarding policy in place and that staff were familiar with it.

We found that care plans were comprehensive and up to date. They gave staff all the information they needed to provide consistently good care.

The home had suitable arrangements in place to monitor the quality of the service it provided.

Inspection carried out on 14 February 2011 and 18 September 2012

During a routine inspection

We spent six hours at the home. While we were there we spoke to people who use the service and two visitors about the care the person they visit receives, and their view about the quality of care given.

It was clear several people were not able to share their views of what it was like to live at The Rylands due to their medical conditions. As a result we made sure we spoke to people close to some of these individuals as part of our telephone survey as we were not able to meet them during our visit.

People we spoke to told us they were happy with the care they receive and that the staff are,

"Lovely, very helpful, they are very, very good.”

Everyone we spoke to stated they would recommend The Rylands if they had similar family circumstances. One visitor said,

“As far as my family are concerned we are very happy with the care provided.”

One person who lives at the home told us.

“This is where I need to be. This place is first class.”

People told us that the meals are generally very good and that they are always given a choice.

People told us they were happy with the laundry service.

People told us they were happy with their bedrooms and that the home is always kept spotlessly clean and tidy.

We were told there always seem to be enough staff on duty and that staff are thoughtful and always help where needed.

A relative told us that the communication from the home is good and that they are kept up to date with any changes in their relative's condition.

Staff told us that they enjoy working at the home and that they are well supported. They said that they have good training opportunities. They were able to tell us about the individual needs of the people they care for.