Ravenscroft Rest Home Limited

Ravenscroft Rest Home Limited is registered to provide accommodation and personal care for up to 34 older adults who require support with their personal care needs. At The time of the inspection there were 27 living at the home.

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

Staff kept the building clean and tidy and maintenance checks were in place and up to date. Recruitment procedures were in place and were applied in line with their policy. There were sufficient staff to care for people. Safeguarding training was provided annually and updated. Staff were aware of the processes to follow to enable people to be safe. Risks were assessed in detail and monitored to ensure individuals safety and promoted their independence within a risk framework. People received their medicines safely.

The registered manager had a training programme to support staff to improve their skills and knowledge. One staff member said, “The training is first class, and the manager supports us always to attend courses to improve.” People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Systems to reduce the risk of malnutrition and monitor people’s food and drink were in place. We received positive comments about the quality of meals at the home. One person said, “We have a good cook and lots of homemade food.”

The management team had auditing systems to maintain ongoing oversight of Ravenscroft and an efficient management team provided oversight and guidance for the service. Quality assurance processes ensured people were able to give their views of the service. A relative said, “They were all very approachable and kept us in the know about [relative's] condition and care.”

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

Rating at last inspection

The last rating at this service was good (published 19 October 2018.)

At our last inspection we recommended that the provider ensure their mandatory training schedule for all staff was up to date. At this inspection we found the provider had acted upon the recommendation immediately after the previous inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow Up

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

We found the following examples of good practice.

¿ Staff had received training around the safe use of Personal Protective Equipment (PPE). Sanitiser and PPE stations were available throughout the home. A robust system was in place for staff and other professionals to follow when entering and leaving the building. There were posters in the home to promote best practice guidance on how to put on and take off gloves, aprons and masks.

¿ Admissions to the home were completed following Public Health England guidance. Additionally, people were asked to isolate following any visits to hospital. Social media and electronic tablets were used to communicate with health professionals to promote people’s physical health. People’s wellbeing had been promoted through telephone and video calls and socially distanced garden visits from loved ones.

¿ The registered manager had comprehensive knowledge of good practice guidance and had attended Covid 19 webinars hosted by Lancashire County Council. There was an established staff team to provide continuity of support. Contingency plans were in place should there be a staff shortage.

¿ We saw Covid 19 policies and procedures were in place and current. Additional housekeeping and governance tasks had been completed to ensure the home was clean and hygienic. The registered manager was participating in the whole home testing programme and had arranged testing for residents and staff.

¿We were told about the positive morale throughout the staff team and that management were proud of the way staff and the organisation had worked as a team to protect people they support and colleagues.

Ravenscroft Rest Home Limited is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Ravenscroft Rest Home Limited is registered to provide accommodation and personal care for up to 34 older adults who require support with their personal care needs. At the time of the inspection, there were 32 people accommodated in the home.

The service was managed by 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.

At the last inspection in April 2016 the service was rated 'Good'. At this inspection in October 2018 we found the evidence continued to support the rating of good. However, we found some shortfalls in relation to staff training. Eight of the staff had not completed training in up to nine areas that the provider had deemed necessary for their role. The registered manager addressed these shortfalls immediately after our inspection. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People who lived at the home and their relatives told us they felt safe and were happy with staffing levels. They told us staff provided them with support when they needed it.

People told us the staff who supported them were caring and respected their right to privacy and dignity. They told us staff encouraged them to be as independent as they could be, and we saw evidence of this during the inspection.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Improvements were required to ensure incidents were analysed to identify patterns and lessons learned. Recruitment checks were carried out to ensure suitable people were employed to work at the service.

The majority of staff employed at the home had received induction, training and support and their knowledge demonstrated a commitment to providing high standards of care. However, this was not consistent throughout the staff team. We found some staff had not received training that the provider had deemed essential for the role. The registered manager and the owner took immediate action to address this. However, we would expect this to have been identified and rectified without our intervention. We made a recommendation about staff training.

The service put people's views at the forefront of the service and designed the service around their needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Improvements were required to the process for seeking consent for equipment such as bedrails.

Risk assessments had been developed to minimise the potential risk of harm to people who used the home. These had been kept under review and were relevant to the care and support people required. Care plans were in place detailing how people wished to be supported.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. We noted some improvements were required to the documentation for medicines prescribed as ‘as required medicines’. The registered manager took immediate action to rectify this.

We found people had been assisted to have access to healthcare professionals and their healthcare needs were met and reviewed regularly. Feedback from health professionals was positive.

People had been supported with various activities of their choice. There was a strong emphasis on maintaining people’s independence and ensuring people remained active members of their local community.

People who used the service and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available, and people said they were encouraged to raise concerns. Staff had received compliments from people's relatives.

People living at the service and staff were happy with how the service was being managed. They found the registered manager and owner approachable and supportive.

The registered manager and staff had worked collaboratively to maintain standards in the home. The governance systems had continued to be reviewed since our last inspection. A variety of audits and checks were completed regularly by the registered manager and the owner. These included regular internal audits of the service, surveys and staff and peoples’ meetings to seek the views of people about the quality of care being provided. We found that the majority of the audits completed were effective in identifying areas of improvements. Although we found shortfalls in staff training, it was evident that there was a commitment from the staff, the provider and the registered manager to maintain high standards of care and to continue improving the home.

The home is registered to provide 24 hour residential care for up to 34 older people with a range of care needs. At the time of our inspection there were 28 people living in the home.

The home had a registered manager in post. 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 felt safe living in the home and staff knew how to keep them safe. People felt supported because staff were always nearby to help them when needed. The provider's recruitment procedure included checks to ensure the suitability of staff before they were employed. Safe care practices and systems in place reduced the risk of harm to people. Medicines were managed appropriately and people received them when needed.

People were cared for by staff who were trained and received regular supervision sessions with the registered manager. Staff were aware of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Where people were unable to make a decision about their care, a best interest decision was made on their behalf, in line with guidance. People had access to external healthcare services to help ensure their medical needs were met. Staff were aware of people's dietary needs and people were supported to eat and drink sufficient amounts.

People were treated with kindness, compassion and were supported to be involved in planning their care. People's diverse needs were respected and staff ensured people's privacy and dignity were maintained. People were encouraged to be involved in their assessment and care planning. People felt confident to share their concerns with the registered manager or staff and complaints were well managed.

People were given an annual quality assurance survey to complete and this gave them the opportunity to tell the provider about their experience of using the service. Regular meetings with staff gave them the opportunity to be involved with changes to the service. There was a clear leadership and people knew who was running the home. Governance systems were in place to promote good standards of care.

During this inspection we gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives and the staff supporting them, the manager and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt safe living at the home. Safeguarding procedures were in place and staff were fully aware of actions they needed to take, should they be concerned about someone's safety.

Plans of care and risk management plans were in place. These were detailed and provided guidance for staff on people's individual needs. People were not put at unnecessary risk, but also had access to choice and remained in control of decisions about their care and lives.

Is the service effective?

People's health and care needs were assessed with them or their relatives and they were involved in writing their plans of care. People said their current needs were being fully met by a kind and considerate staff team. We established that a range of external professionals were involved in the provision of care. This helped to ensure people received the correct health care to meet their needs.

Those working at the home told us they received plenty of training and gave us some good examples of courses they had completed.

Is the service caring?

We spoke with four people who lived in the home. We asked them for their opinions about the staff that supported them. Feedback from people was consistently positive. For example, one person commented: "It's a good place to be", another said; "The staff are very caring...It's very pleasant and relaxed."

When speaking with staff it was clear that they genuinely cared for the people they supported. People who used the service and their relatives, completed satisfaction surveys. Where shortfalls or concerns were raised these were taken on board and dealt with. People's preferences and interests had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

We noted that staff responded to the needs of people in a timely fashion and anticipated their needs well. This was because staff members were familiar with the needs of those in their care and had developed a good understanding of those living at the home.

People knew how to make a complaint if they were unhappy and felt they would be listened to, should they wish to make a complaint or raise any concerns. Comments and complaints were taken seriously and used to make improvements to the service.

Is the service well-led?

It was clear the manager and provider led by example and staff felt supported. People were aware of the lines of accountability within the home and it was evident that those living at the home trusted the manager and their staff team.

The service had a quality assurance system in place and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

We reviewed the care records of four people who used the service. We found there were systems in place to ensure people consented to the care and treatment they received. We saw care plans clearly identified people's needs and included information on how they wished their care to be delivered.

We found there were appropriate arrangements in place for the safe administration of medicines.

We found the premises were safe and secure and had been decorated and maintained to a good standard. All the people we spoke with told us they felt safe and comfortable within the home.

We spoke with three members of care staff and the activity coordinator employed to work in the home. They told us they felt well supported and confident in carrying out their responsibilities. We saw evidence that staff were appropriately qualified and provided with training relevant to their role.

We found there were effective systems in place for the completion and storage of records relating to the care of people who used the service and the maintenance of the premises.

At the time of our visit the dining room was being refurbished and a temporary dining room established in one of the communal areas. The people living in the home we spoke with were keen to tell us about the improvements and that they had been involved in choosing the new d'cor.

Staff we spoke with could tell us what action they should take to protect people from harm if it was to occur. They also told us they would feel confident to report any concerns about about fellow workers if they thought they were not working in the correct mannner.

We reviewed the recruitment records of three staff and found that they had been recruited using an effective procedure that included all of the appropriate checks to ensure that the person being employed was of good character.

People we spoke to told us they had no complaints about the service but would be happy to raise their concerns with the staff or matron. One person told us, "I don't bother with the residents meetings, I would just tell matron if something was wrong".