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Ryefield Court Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 17 January 2019

This comprehensive inspection was unannounced and took place on the 20 and 22 November 2018. At our last comprehensive inspection on the 14 March 2017 the service was rated outstanding.

Ryefield Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. In the case of Ryefield Court, no nursing care is provided. The home can accommodate up to 60 people in one adapted building over three floors which are run as separate units, each of which have separate adapted facilities. The unit on the second floor specialises in providing care to people living with dementia.

The registered manager who was in post at the last inspection had left and at the time of this inspection, there had been a new registered manager in post for two months. ‘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.’

During the inspection we found some aspects of medicines management were not always carried out safely. The provider introduced plans to address the areas that required improvement when we pointed these out to them.

The provider’s arrangements around the control and spread of infection were not always effective. We identified several issues which fell short of good practice.

People did not always receive person centred care that met their needs. A few people were woken up early in the morning when there were no indications that this met their needs, wishes or preferences.

Care plans were not always person centred and detailed, to address how people’s needs were to be met. For example, the care plans to support people with their elimination care needs did not make clear how these needs would be met.

The provider’s quality assurance systems and governance arrangements were not always effective because they had not identified the shortfalls we identified at this inspection, so they could make the necessary improvements and protect people from the risk of receiving unsafe and inappropriate care. Once we pointed out the shortfalls, the provider started to address these promptly.

Whilst the home provided a warm, clean, well maintained and inviting environment for people, the unit for people with dementia did not always support their orientation and independence because of a lack of signage, the use of colour and features. We have made a recommendation to the provider about this.

The provider had recruitment processes which were not always adhered to robustly. The registered manager stated they would make sure that these were adhered to as required.

The provider had policies and procedures in place to protect people from abuse. Staff we spoke with had received training and knew how to respond to safeguarding concerns.

Staff had up to date training, supervision and annual appraisals to develop the necessary skills to support people using the service.

People's dietary and health needs had been assessed and recorded so any dietary or nutritional needs could be met. People were supported to maintain healthier lives and access healthcare services appropriately.

The provider worked within the principles of the Mental Capacity Act (2005). People were generally supported to have choice and control over their day to day decisions.

Before coming to the service, the provider undertook an assessment to determine if the service could meet the person’s needs.

There was a complaints procedure in place and the provider responded to complaints as per their procedure.

People using the service and staff told us the registered manager was available and listened to them.

We found three

Inspection areas

Safe

Requires improvement

Updated 17 January 2019

The service was not always safe.

The provider did not have effective arrangements to ensure medicines were always managed safely.

The recruitment procedures were not always adhered to which meant there were risks that people not suitable to work at the service, might be employed.

The standard of practice relating to the control and spread of infection fell short of the provider’s procedures.

The provider had safeguarding policies and procedures and staff knew how to respond to safeguarding concerns.

Effective

Requires improvement

Updated 17 January 2019

The service was not always effective.

Whilst the home provided a homely, warm and well maintained environment, these did not necessary meet all the needs of people, particularly if they were living with dementia.

The principles of the Mental Capacity Act (2005) were being followed.

Staff were supported to develop professionally through training, supervision and annual appraisals.

People were supported with their dietary requirements and to meet their healthcare needs.

Caring

Requires improvement

Updated 17 January 2019

The service was not always caring.

Waking people up early in the morning without an appropriate reason, did not demonstrate people were being treated with care and compassion.

We observed other instances where staff treated people with kindness and respect and observed people were given choices.

Feedback from people using the service and their relatives was positive.

Responsive

Requires improvement

Updated 17 January 2019

The service was not always responsive

Care plans were not person centred and did not always detail clearly how people’s needs were to be met. Some care practices did not consider people’s needs, preferences and their likes and dislikes.

The support plans recorded some information around people’s wishes, views and thoughts about end of life care.

There were a variety of activities that people accessed.

The service had a complaints procedure and people knew how to make a complaint if they wished to.

Well-led

Requires improvement

Updated 17 January 2019

The service was not always well-led.

The provider had quality assurance processes, but these were not effective in making sure the service continued to provide an outstanding service. These had not identified the concerns we found at this inspection so they could be addressed.

People using the service and staff felt managers were accessible and said they listened to any concerns.