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Inspection Summary


Overall summary & rating

Inadequate

Updated 27 January 2016

This unannounced inspection took place on 01 December 2015. Ramsay Manor is registered to provide accommodation and personal care for 84 people, there were 18 older people living in the service when we inspected.

Ramsay manor was placed into ‘Special measures’ by CQC following the last inspection in April 2015 as they were not meeting the legal requirements. The purpose of special measures is to:

  • Ensure that providers found to be providing inadequate care significantly improve.
  • Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
  • Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Following the last inspection the provider had sent us a detailed action plan which set out what they intended to do to meet the legal requirements. At this inspection we found that some improvements had been made but the provider had not achieved all that they said that they would do. We found that some actions had not been undertaken as planned and others had not been fully implemented. The service did not meet all the legal requirements for the 18 people currently living in the service. We were told that the provider was planning to admit more people and have concerns about the impact of increased numbers on the people already living at the service and the quality of care.

Since the last inspection a new manager has been appointed and has taken up post. They told us that they had applied to CQC to be registered. 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.

We found that the service was only partly open; areas of the building were closed to people and staff as a refurbishment was underway. At the last inspection we found that the layout of the service and the on call system did not promote peoples independence or wellbeing. We found continued problems in these areas. The building also presented significant challenges in terms of staffing due to its size and layout. We found that staff were not always deployed effectively and people had to wait for assistance.

Safety checks were completed but the risk assessments processes were not always effective. We were concerned that the lack of clarity around moving and handling processes could lead to a risk of injury.

Medication was not safely managed. We found issues with the storage and the administration of medication. People did not always receive their pain relief as prescribed.

Since the last inspection significant recruitment had taken place and we found that the provider operated a safe and effective recruitment system. New staff however did not receive a comprehensive induction. Staff knew what abuse was and although they were not all clear about the role of the local authority they knew that concerns should be reported.

We saw that staff were supported to access ongoing training but their understanding of the subject and competency was not accessed. We identified shortfalls in staff understanding of consent, medication and moving and handling. The guidance for staff to follow to meet people’s health needs was not always clear.

People enjoyed their food and received a varied choice of nutritional meals. Support was available for those who needed it

Staff were caring and treated people with kindness. However people’s involvement in decision making was inconsistent. Dignity was not always well understood.

Care plans were in place but they were not always easy to use. This combined with the high numbers of new staff meant that people were at risk of not having their needs and preferences met.

Activities were being undertaken which was a positive development. However further efforts should be made to ensure that they are accessible to all the people living in the service, including those people with a diagnosis of dementia.

The new manager was being supported by an independent consultant and staff were largely positive about the changes that had taken place. Some efforts had been made to consult with people but audits were not well developed. The concerns which were identified at this inspection had not been identified by the registered person

You can see what action we told the provider to take at the back of the full version of the report.

Inspection areas

Safe

Inadequate

Updated 27 January 2016

This service was not safe.

We continued to have concerns about how equipment was being used and how risks were identified and managed

Medicine administration did not always follow professional guidance.

Staff did not always respond to people’s needs and requests in a timely way

Effective

Requires improvement

Updated 27 January 2016

The service was not consistently effective.

Training was provided to staff but the system for checking their understanding of what they had learnt did not work effectively.

There were gaps in staff skills and knowledge. Consent was not well understood

Staff did not always fully understand the health conditions of the individuals they supported

People were supported to have sufficient to eat and drink

Caring

Requires improvement

Updated 27 January 2016

The service was not consistently caring.

Staff interacted with people well and were patient.

Dignity was not always well understood

Care plans did not set out people’s choice for when they reached the end of their life.

Responsive

Requires improvement

Updated 27 January 2016

The service was not consistently responsive

Care delivery was not always personalised and or corresponded with the plan of care

People enjoyed the activities on offer but further development is needed to ensure that they meet the needs of people with dementia.

Well-led

Inadequate

Updated 27 January 2016

The service was not well led

Poor practices were not being identified and addressed.

Audits did not address the inconsistencies in the approach of staff or promote individualised care.