Archived: Ranyard at Dowe House

Updated 7 May 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection was carried out by two inspectors, a specialist advisor and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The specialist advisor was a registered nurse.

Before the inspection, we reviewed the information we had received about the service which included notifications from the provider about incidents at the service. We also reviewed the improvement plan the provider sent us following our last inspection and a monitoring report from the local authority commissioning team. We used these to plan the inspection.

During the inspection we spoke with 14 people using the service and four relatives and friends. We also spoke with the manager, a consultant, the general manager, three registered nurses, seven care staff and a GP. We looked at 14 care records, 10 people’s medicines administration record charts and four staff records. We also reviewed records relating to the management of the service including complaints, quality assurance reports and health and safety records.

We undertook general observations of how people were treated by staff and how they received their care and support throughout the service. We used the Short Observational Framework for Inspection (SOFI) during lunchtime. SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 7 May 2015

Ranyard at Dowe House provides accommodation and nursing care to up to 51 older people, some of whom had dementia. There were 40 people using the service at the time of this inspection.

This unannounced inspection took place on 29 January and 5 February 2015. The last inspection of Ranyard at Dowe House took place on 18 July and 1 August 2014. We found then that the service was not meeting the outcomes relating d to the care and welfare of people, respecting and involving people, management of medicines, staffing levels, supporting workers, record keeping, assessing and monitoring the quality of service, and notifications. We asked the provider to take action to make improvements. They sent us an improvement plan which stated that they would address the issues found within six months of our inspection.

At this inspection, we found that the provider had made improvements and were still making progress with implementing their action plan fully. For example, staffing levels had increased, there was now a system in place to ensure staff were supervised and supported, notifications were being sent to us as required, a new manager had been appointed, care planning had improved to reflect people’s needs and processes had been put in place to monitor the quality of service provided.

The service did not have a registered manager. The manager had submitted their application to be registered as the manager of the home with the Care Quality Commission. 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.

The environment was not maintained to ensure it was safe for people. There were flammable materials left around. Fire drills were not conducted regularly so that staff could practice evacuation in the event of an emergency.

Staff had not been trained in the Mental Capacity Act 2005 and capacity assessment had not been completed as required where there were doubts about a person’s capacity to make decisions.

The views of people were not always obtained when planning the menu and activities. The cultural and religious needs of people were not always met.

People received care and support in a safe way. Medicines were kept securely and people received their medicines as prescribed. The service identified risks to people and had appropriate management plans in place to ensure people were safe as possible.

Staff were knowledgeable in recognising the signs of abuse and knew how to report it following their procedures. People were not unlawfully deprived of their liberty.

There were sufficient staff available to meet people’s needs. People told us staff were kind and caring. We observed that people were treated with dignity and respect by the staff. People were supported to communicate their views about how they wanted to be cared for. People told us they enjoyed the food provided. People’s nutritional and dietary needs were met.

Training programmes had been developed to ensure staff had the skills and knowledge to provide good care to the people they looked after. Staff received the support and supervision to carry out their duties effectively.

People had their individual needs assessed and their care planned to meet them. People received care that reflected their preferences and choices. Reviews were held with people and their relatives to ensure their support reflected their current needs.

The manager responded appropriately to complaints about the service. Systems had been put in place to check and monitor the service to ensure it was of good quality and met people’s needs.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the back of the full version of this report.

We made two recommendations about planning staffing levels and obtaining the views of people.