Ravenstone Care and Rehabilitation Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of the legal regulation in relation good governance.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

An effective system was not fully in place to assess people’s needs. We identified shortfalls in how people’s needs were assessed in relation to risk management, medicines, mental capacity, the provision of equipment, and support for people’s behaviours; examples of these are outlined throughout this report.

Care plans and risk assessments contained conflicting and inaccurate information because staff were unable to remove outdated records. For example, 1 person’s care plan contained conflicting information about their skin integrity, with one entry stating their skin was intact and another recording skin damage. In addition, people’s care plans and risk assessments had not been updated following several safeguarding incidents. This meant staff did not always have clear, accurate, or up‑to‑date information to guide their practice, which increased the risk that people’s needs were not safely or appropriately met.

Following our assessment, the registered manager and nominated individual told us that these issues were being addressed and that training and support were being provided to staff in relation to the electronic care management system.

Despite these concerns, relatives told us they felt people’s needs were assessed. One relative told us, “Yes, the manager assessed her needs. She had lunch at this home and had a transition here. We bought some new things like CDs, pictures, and a new coffee table, and she recognised them. They know all about her.”

An effective system was not fully in place to ensure care and support were delivered in line with best practice. Equipment was not always available to support people’s safety and independence, safely. An activities coordinator was on duty 2 days a week and some relatives told us people would welcome more meaningful activities, including opportunities for people to go out for walks. One relative told us, “She complains that she doesn’t go out enough…Carers say that there isn’t enough staff to have a staff member to take someone outside for a walk.” In addition, records did not consistently demonstrate that staff were following best practice when supporting people whose behaviours placed themselves or others at risk.

Arrangements for meeting people’s nutritional needs did not always align with best practice. Care staff were responsible for cooking meals in addition to providing care. Menus showed that some meals included a reliance on processed foods. The registered manager told us there was an emphasis on home baking.

Despite these shortfalls, relatives spoke positively about the care provided. One relative told us, “It looks after people with severe mental health issues in a dignified and homely setting. I don’t think they could do any better and they are all nice and friendly.”

Following our assessment, the registered manager told us that a cook was in the process of being recruited, interviews were being carried out for new care staff and activities provision had increased to 3 days a week.

An effective system was not fully in place to ensure staff worked well across teams and services to support people. Staff handovers took place in the kitchen due to a lack of dedicated space and were delivered verbally, which meant some important information about people’s care was not always shared or recorded. Following our assessment, the registered manager told us they would review the handover arrangements. Staff meetings had not been carried out as regularly as planned. This meant communication systems were not consistently embedded, management oversight was limited, and staff were not always fully informed about people’s needs.

However, staff told us they felt communication within the team was good, and we received positive feedback from a health and social care professional about their experiences of working with the service. Relatives also said overall said communication was good. One relative said, “I’m updated and informed of anything.”

An effective system was not fully in place to support people’s health and wellbeing. Equipment and adaptations were not always available to promote people’s health, safety, and independence, and some relatives told us that people would benefit from a wider range of activities to support their wellbeing. Records relating to people’s care and support were not always accurate, this meant staff did not always have clear, up‑to‑date information to guide their practice.

Despite these shortfalls, relatives spoke positively about people’s access to healthcare. One relative told us, “They contact the GP and there is a paramedic attached to the home and they have a specific GP practice.” A health and social care professional also provided positive feedback. They told us the service engaged well with clinics and brought appropriate referrals and concerns to their attention and were responsive to any requests made.

During our visit, a health professional attended the home. We also saw evidence that the service liaised with external professionals, including district nurses, social workers, paramedics, GPs and the mental health team.

Systems to monitor and improve outcomes were not always effective. Although information was available through incidents, audits, safeguarding concerns and external feedback, this was not consistently analysed or used to identify trends or drive sustained improvement. As a result, recurring issues remained across areas such as care planning, risk management, medicines management, safeguarding, staffing, training, and environmental safety, demonstrating that outcomes were not always improved over time.

There was no evidence that incidents and accidents were analysed to identify patterns or learning that could improve outcomes. While audits were completed in some areas, including medicines management, identified shortfalls were not consistently followed by action plans or reviews to ensure improvements were implemented and sustained.

External feedback, including repeated concerns raised by the local authority about care planning, risk assessment, staffing, and training, was not effectively used to strengthen systems or improve people’s experiences.

However, despite these shortfalls, relatives spoke positively about the impact of care on people’s wellbeing. One relative told us, “She is so much different here, she doesn’t stay in her room now and is out in the communal areas. It has a lovely family feel and we see the same carers all the time and it's a family feel.”

An effective system to demonstrate how staff were applying the Mental Capacity Act 2005 (MCA) was not fully in place. The MCA provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves and requires that people are supported to make their own decisions wherever possible. Where people lack capacity to make specific decisions, any decision made on their behalf must be in their best interests and be the least restrictive option.

Records did not consistently demonstrate how staff were applying the Mental Capacity Act in practice. For example, sensors were in place for several people to monitor their movements; however, there was no evidence of completed mental capacity assessments or best interests decision making to show that people had consented to, or lacked capacity regarding, the use of sensors. In addition, records did not always demonstrate appropriate capacity assessments or best interests decisions for significant decisions such as living at the home. This meant there was insufficient assurance that decisions were being made lawfully, in people’s best interests, and in the least restrictive way, increasing the risk that people’s rights and freedoms were not fully protected.