The Raikes Residential Home

This inspection took place on 7 September 2017 and was unannounced. At the last inspection on 9 May 2016 we rated the service ‘Requires Improvement’ overall and identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. On this inspection we found this regulation had been met and no further breaches of regulation were found.

There was 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.

The home had a safeguarding policy in place which made staff aware of their roles and responsibilities. We found staff knew and understood how to protect people from abuse and harm and kept them as safe as possible. People told us they felt safe because the staff were caring and because the registered manager listened to them and acted quickly if they raised concerns.

There were enough staff on duty to meet people’s needs and staff had undertaken training relevant to their roles. Staff told us there were clear lines of communication and accountability within the home and staff meetings were held to keep them up to date with any changes in policies and procedures or anything that might affect people’s care and treatment.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act 2005 (MCA).

People told us they enjoyed the food and we saw people’s weights were monitored to ensure they had sufficient to eat and drink.

We saw the complaints policy had been made available to everyone who used the service. The policy detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received.

The care plans in place were person centred and identified specific risks to people health and general well-being, such as falls, mobility, nutrition and skin integrity.

We saw arrangements were in place that made sure people's health needs were met. For example, people had access to the full range of NHS services. This included GPs, hospital consultants, community health nurses, opticians, chiropodists and dentists.

We found medication policies and procedures were in place and staff responsible for administering medicines received appropriate training.

There was a quality assurance monitoring system in place that was designed to continually monitor and identified shortfalls in service provision. Audit results were analysed for themes and trends and there was evidence that learning from incidents took place and appropriate changes were made to procedures or work practices if required.

We last inspected this service in March 2014 and found it was meeting all of the regulations inspected at that time.

The Raikes Residential Home is registered to provide residential care for up to 31 people. Most of the people who use the service are older people, some of whom live with dementia. On the day of our inspection 31 people lived at the home. The home is situated just outside the village of Silsden. Accommodation is provided in single rooms on the ground and first floors. Two passenger lifts provide access to the first floor.

At the time of this inspection the manager was not registered with the Commission. However, following our inspection they submitted an application to become the 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.

People we spoke with told us they felt safe and did not raise any concerns about the way they were treated. Staff were aware of action they would take to keep people safe such as in the event of an emergency or if they were concerned someone was at risk of abuse. We found safeguarding concerns were being referred to the local safeguarding team but the Commission was not always being notified about them.

We found some care records were not complete and did not always demonstrate that risk had been mitigated. The manager was in the process of updating all care records to ensure they were sufficiently detailed and contained person centred information.

Overall risks to people’s health, safety and welfare were identified and action taken to manage the risk. However, care records did not always fully reflect the risk reduction strategies staff followed.

Our observations, discussions with people and review of records led us to conclude there were sufficient staff to meet people’s needs.

Overall we concluded there were processes in place to make sure people’s medicines were managed safely. However, some improvements were needed to ensure a consistent approach. We recommend the provider reviews and revises their protocols for ‘as required’ medicines to ensure they are developed in line with current guidance and provide clear guidance for when people should be provided with these medicines.

We concluded the manager was taking appropriate action to implement an effective system of staff training but there was still work to be done in this area.

We found the premises to be clean, tidy, appropriately furnished and homely. Some window restrictors needed to be replaced to ensure they met current guidance. Following our inspection the manager arranged for this work to be completed.

People told us the food was good and our observations showed people received sufficient food and drinks. However, care records did not always evidence nutritional risk had been effectively managed, especially in relation to people’s fluid intake.

People provided positive feedback about the standard of care provided and told us staff were kind and caring. We saw staff knew people well and used this knowledge to provide care which met people’s individual needs. Staff treated people with respect and dignity and offered support in a kind and sensitive way.

Staff supported people to see other health care professionals so they could maintain good health and we saw examples where staff had made referrals where they were concerned about someone’s health and wellbeing. The advice provided by health care professionals was not always reflected within care records.

Assessments and applications had been made to ensure the rights of people with limited mental capacity were protected in line with the legal framework of the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005. Staff had a good understanding of their responsibilities in protecting the rights of the people they cared for.

Staff encouraged people to make decisions about how they wanted their day to day care to be delivered. We saw staff took time to explain things to people and offered choices so people were able to make informed decisions.

The feedback we received from people who used the service and their relatives indicated the activities programme needed further improvement. The manager and provider were in the process of addressing this but we concluded further improvements were still required.

Since coming to post the manager had started to implement additional opportunities for involvement such as structured care reviews and resident meetings. Relatives particularly welcomed these changes as they said the service had not always been good at keeping families informed and involved in the past.

The manager had developed an improvement plan which identified the areas where they needed to focus on implementing change. They had also implemented systems to audit the quality and safety of the services provided and identify for themselves others areas where improvements were needed. We saw examples where these checks had been effective in identifying and addressing areas for improvement.

However, it was too early to test the long term effectiveness of these audits. We were also unable to see evidence there had been robust quality assurance systems in place prior to the new manager coming to post. Some areas for improvement were identified by the Commission, rather than being identified through the service’s own quality assurance processes.

The feedback about the new manager was positive and we saw they promoted an open and honest culture. We concluded that the provider, manager and staff team were committed to making the required improvements, helping to positively change the culture of the organisation and to ensuring people received good quality care.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We briefly spoke with one person who used the service during the inspection and they appeared comfortably and cheerful. We noted their bedroom was clean and tidy and their commode was also clean.

We found the majority of the environment of the home was visibly clean but attention to detail was lacking with some equipment and high surfaces. We also found hand washing and drying facilities for staff were not easily accessible and washing of commode pans was conducted in the laundry room.

We found staff were supported in their role and offered the necessary training that ensured they had the right knowledge and skills. We also found there was a suitable complaints process and people who used the service had the complaints process discussed with them during admission to the home.

We spoke with four people who used the service, one person said "I get on well with the girls and wouldn't want to move from the home." They also said the food was good and they had a laugh. Another person said they were very happy at the home and had no complaints. Another person who used the service said they were 'comfortable and happy".