Archived: Mavesyn Ridware Residential Home Limited

Mavesyn Ridware Residential Home Limited is a residential care home providing care to 12 people aged 65 and over at the time of the inspection. The service can support up to 21 people in one building.

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

People continued to be at risk of harm as the registered manager and provider had not assessed and mitigated risks to people. This included risks in the environment of the home as well as risks associated with people’s health and care needs.

Medicines continued to be managed unsafely which meant the provider could not be sure people got the medicines they needed, when they needed them.

People had not been protected from the spread of infection because suitable systems and processes were not in place.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The registered manager and provider had not implemented systems that were effective in identifying improvements and ensuring changes happened when they were needed. This meant that people continued to receive care that was not safe.

The registered manager and provider had not complied with their lawful duties to notify CQC of required events and had not displayed their current rating at the service.

There were enough staff that had been safely recruited to support people. However, staff did not have the guidance they needed to support people safely.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 25 December 2020 with a supplementary report published April 2021) and there were three breaches of regulations.

At this inspection enough improvement had not been made and the provider was still in breach of those regulations with additional breaches of regulations.

This service has been in Special Measures since the last inspection. During this inspection the provider demonstrated that enough improvements had not been made. The service continues to be rated inadequate. Therefore, this service continues in Special Measures.

Why we inspected

We received concerns about a lack of improvement since the last inspection and people continuing to be placed at risk. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We did not inspect the other key questions. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service remains inadequate.

You can see what action we took at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mavesyn Ridware Residential Home Limited on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified seven breaches at this inspection. These breaches relate to safe care and treatment, management and governance, consent, person-centred care, safeguarding people from unlawful deprivations of liberty, failure to display the most recent CQC rating and failure to notify CQC of required incidents.

We took enforcement action to cancel both the manager and the provider's registration with us.

Follow up

We will continue to work with the local authority, other professionals and stakeholders to monitor the service. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Mavesyn Ridware Residential Home Limited is a care home providing personal care and accommodation to 11 people aged 65 and over at the time of the inspection, some of which were living with dementia, a physical disability or sensory impairment. The service can support up to 21 people in a single adapted building.

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

Systems were not effective at identifying areas that needed improving in a timely manner. Risks were not

always assessed, planned for and mitigated to keep people safe as assessments were not always

personalised.

Systems were not sufficiently in place to safeguard people from abuse. Safeguarding’s had been raised but the registered manager did not have systems to record and act upon these concerns.

The registered manager failed to ensure that people’s care records were accurate and up to date. The registered manager and provider did not undertake audits of people’s care records.

Systems were not in place to manage medicines safely. Medication audits had been completed, however, they failed to highlight issues that were found during the inspection.

The principles of the Mental Capacity Act 2005 (MCA) were not applied consistently. The registered manager had not always carried out mental capacity assessments for some people and there were not best interest decisions to support staff when providing care for people.

The provider did not have clear systems in place to ensure the home was clean. The home was unkempt, we found cobwebs on the ceilings, curtains and the pelmet.

There were enough staff to support the needs of people during the days of inspection.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 August 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Mavesyn ridware residential home limited on our website at www.cqc.org.uk.

Why we inspected

We received concerns from the local authority after they raised a number of safeguarding’s which related to the care people were receiving in the home.

The ratings from the previous comprehensive inspection for those key questions not looked at on this

occasion were used in calculating the overall rating at this inspection. The overall rating for the service has

changed. We did not inspect effective, caring and responsive due to us wanting to limit ourselves and spend the least amount of time in the home as possible.

Follow up

We identified concerns at this inspection. We will therefore aim to re-inspect this service within the published time scale for services rated Inadequate. We will continue to monitor the service through the information we receive.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified three breaches. Regulation 11 had not ensured that care and treatment was provided with consent from the relevant person, furthermore, the provider had not followed the principles of the MCA. Regulation 12 the registered person failed to ensure risks relating to the safety, health and welfare of people using the service were assessed and managed safely and the registered person failed to ensure the proper and safe management of medicines. Regulation 17 the registered person had not established an effective system to enable them to assess, monitor and improve the quality and safety of the service provided.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There were enough staff to support people with specific tasks but not for activities or one to one time with staff.

Staff were not consistently following risk management plans. Staff were recruited safely, and staff received training to be effective in their role and felt supported.

People had their risks assessed and planned for. People received their prescribed medicines and measures and protocols had been put in place for people who needed ‘as required’ medicines.

People were protected as staff understood their safeguarding responsibilities and followed infection control procedures.

Lessons had been learned when things had gone wrong. People were supported to access other health professionals when they needed them.

People were involved in decisions about their care and supported to be as independent as possible.

People and relatives knew how to complain and felt able to; action was taken following a complaint.

People were supported to put end of their life plans in place that contained personalised detail.

We have recommended the provider assesses the layout or design of the dining room.

The service met the characteristics of Requires Improvement in most areas. More information is in the full report.

Rating at last inspection:

At the last inspection, the service was rated Requires Improvement overall (report published 03 May 2018) With a breach of Regulation 17. At the last three inspections we have asked the provider to make improvements.

Why we inspected:

This was a routine inspection planned on the previous rating.

Follow up:

We will continue to monitor the service and check improvements have been made at our next inspection.

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

Mavesyn Ridware is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were 18 people using the service.

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.

This inspection was unannounced. Mavesyn Ridware was last inspected in January 2017 and the service was rated as Requires improvement. We identified concerns as systems to monitor and improve the service had not always been effective and improvements were needed to ensure medicines were managed safely. Where people lacked capacity to make some decisions, this had not been suitably assessed to ensure decisions were in people’s best interests.

At this inspection, we saw that improvements had not been made. This is the third consecutive time the service has been rated ‘Requires Improvement’. Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not effective.

People felt that there were enough staff to meet their needs and they felt safe. However, they were not always able to summon support when staff were not visible to them. Improvements for how medicines were managed had not been made and staff were making decisions about how some prescribed medicines were given.

People had access to healthcare services, however where people needed support with eating or drinking, a referral had not been made to ensure they remained safe and well. People were not supported to have maximum choice and control of their lives. Improvements had not been made to ensure people’s capacity to make specific decisions had been assessed.

Staff generally developed caring relationships with people however, their privacy and dignity was not always respected. Interactions with people was often focused around when personal care was delivered.

Visitors were welcomed at any time. People knew who the registered manager was and the staff felt they were approachable and provided support to them. People were able to share their views though a survey, although meetings to gain their views were no longer carried out.

Staff received opportunities to receive training and support to enable them to fulfil their role and they were encouraged to develop their skills. The staff recognised where people may be at risk of harm and understood their responsibilities report abuse. Mealtimes were not rushed and people enjoyed the food that was prepared.

We found breaches 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.

Mavesyn Ridware provides residential for up to 21 older people, some of whom may be living with dementia. There were 19 people resident at the time of our inspection. 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.

Systems to monitor and improve the service had not always been effective in identifying improvements needed to ensure medicines were managed safely. Where people lacked capacity to make some decisions, this had not been suitably assessed to ensure decisions were in people’s best interests.

Staff understood their role in protecting people from the risk of harm and people were supported by staff who had the knowledge and skills to provide safe care. There were sufficient staff available to meet the identified needs of people who used the service in a way that they wanted this.

People were supported to eat and drink what they liked. Where concerns were identified, people received support from health care professionals to ensure their well-being. Health concerns were monitored and people received specialist health care intervention when this was needed. Medicines were managed safely and people received their medicines at the right time, as prescribed.

People were treated with dignity and respect and had their choices acted on. The staff were kind and caring when supporting people. People were confident that staff supported them in the way they wanted. Staff knew people’s likes and dislikes and people’s preferences were considered and incorporated in their support plan. There were regular reviews of people’s care to ensure it accurately reflected their needs.

People enjoyed the activities and opportunities to socialise. People were able to stay in touch with people who were important to them as visitors could come to the home at any time. People knew who to speak with if they had any concerns and they felt these would be taken seriously. Arrangements were in place so that actions were taken following any concerns being raised.

We found a 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.

Mavesyn Ridware provides residential for up to 21 older people, some of whom may be living with dementia. There were 19 people resident at the time of our inspection.

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.

People made decisions about their care and staff sought people’s consent before they provided care and support. Where people were not able to make decisions for themselves because they may lack capacity, the provider had not always assessed whether people could make these decisions themselves; this meant that some decisions that had been made may not be in their best interests. Some applications to restrict people of their liberty had been made without ensuring that the person did not have the capacity to make the choice. We have asked the provider to make improvements.

Staff were available at the times people needed them and staff had received training so that people’s care and support needs were met. The provider had not introduced the new Care certificate for new staff to ensure they developed and demonstrated key skills, knowledge, values and behaviours which should enable them to provide people with safe, effective, compassionate and high quality care.

Staff understood their responsibility to safeguard people from harm. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks. Risk assessments ensured people could continue to enjoy activities as safely as possible and maintain their independence.

There were processes to review the experiences of people who used the service. This was through regular communication with people and staff to make sure people were supported in the best way. Arrangements were in place so that actions were taken following concerns raised, for the benefit of people.

People were confident that staff supported them in a manner which protected their welfare and they told us they felt safe. Staff had a good understanding and knowledge of safeguarding people and understood what constituted abuse or poor practice. Where harm or abuse was suspected, the staff knew how to respond to protect people.

People received support from health care professionals where they needed this to keep well. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

People were supported to eat and drink and there was a choice of foods available. Specialist diets were catered for and alternative meals could be provided upon request. People received support to remain independent at meal times and where they needed assistance, this was done in a caring and supportive way.

People were treated with kindness and compassion by staff who knew them well. We saw that people’s privacy and dignity was respected and people were called by their preferred name. People were confident that staff supported them in the way they wanted.

People knew how to make complaints. They were confident that the staff and registered manager would respond to any concern and they could approach them at any time. Complaints were managed in line with the provider’s complaints procedure and people were informed of any investigation and actions.

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

Following the previous inspection the provider sent us information to tell us how they were going to become compliant with the regulations. At this inspection we saw that improvements had been made.

When we visited previously 'end of life' plans had not been completed appropriately to ensure people's wishes were followed. On this inspection the home had improved these plans and they included evidence that a medical professional had authorised decisions.

People living at the home had the opportunity to take part in some activities. The manager told us that there were plans in place to further develop this aspect of people's care.

The provider had made progress in putting in place a system to review and monitor the quality of the care people received but this had not yet been fully implemented. Audits had been completed to make sure that the people were protected from the risks of infection. A medication audit was in the process of being completed.

People were satisfied with the care they received. We spoke with nine people. One person told us: 'The staff are kind, I find it very good here I have no complaints'. Another person said: "I have my ups and downs but on the whole it's okay here'.

Plans of care had improved. We spoke with staff and they told us how they provided care for people each day. We looked at two care plans and the information recorded in the plan corresponded with what staff had told us. People's care was being evaluated every month. Care staff had been trained in manual handling and people were now being moved in a safe way. We saw in two files that end of life plans and preferences had not been completed properly. Decisions not to resuscitate people had not been approved by a medical professional.

Records confirmed that care staff's training had improved since our last inspection. Training to meet people's needs had been provided.

The provider had made some improvements to the way the service was monitored and reviewed. Relatives had been asked for their views about the service. Audits that were completed on the quality of the service were not recorded and therefore there was no information to show that any shortfalls had been acted upon.