Archived: Ravenstone

Ravenstone 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. The provider of Ravenstone is registered to provide accommodation and nursing care for up to 43 people who have nursing needs. At the time of this inspection 36 people lived at the home.

The provider had a registered manager in place who supported this inspection. 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.

Our last inspection took place on 28 and 29 June 201, we rated the service as 'Requires Improvement’. We identified five breaches of the regulations. These included the provider had not make sure risks to people from avoidable harm was reduced. The staffing arrangements did not reduce risks of people care needs being met in a safe and timely way. Staff did not respond to people's needs in a way which promoted care was centred on their needs and their dignity was respected to enhance their welfare. The provider did not effectively use their quality checks to bring about improvements in a timely way so people lived at a home where high-quality care was promoted.

As a result of the inspection, we asked the provider to send us a report explaining the actions they were going to take to improve the service.

At this inspection we found the registered provider’s oversight and quality checks were more effective. These were used to drive through improvements to support people’s needs in a timely way and safely, with people at the heart of all their care. The provider had now met legal requirements in these areas although further improvements required.

People’s medicines were available to them as prescribed however the management of medicines needed strengthening to ensure risks to people continued to be reduced. Risks to people's safety from avoidable harm and injury in relation to some electrical items had not been assessed so actions to minimise identified risks completed. Staff practices in infection prevention and control was not effective in all areas of the home environment so the spread of infections continued to be reduced.

People’s needs were responded to and met without any unreasonable delays which was an improvement made since our last inspection. Staff were knowledgeable about the subject of abuse and what actions to take if they had concerns. The provider had systems in place to support staff in reporting accidents and incidents. The management and staff team used learning from accidents and incidents to inform their caring practices and continually improve.

Staff were supported to maintain and improve their skills through ongoing training and support from the registered manager and deputy manager. Checks were completed before staff started to work at the home to ensure they were of good character and safe to work with people living at the home.

People’s individual needs were assessed when they came to live at the home and regularly reviewed. Staff worked well together to meet people’s varied needs and where people would benefit from equipment this was provided. People were referred to healthcare professionals when needed and staff followed the guidance shared with them.

People were encouraged and supported to eat a nutritional diet which met their needs and recognised their choices. Risks to people's nutritional health had been assessed and when weight loss was identified, people were not offered extra calories in their meals or as snacks. Drinks were offered to people and support was given when needed including people having their drinks left within their reach.

People’s needs were met by the adaptation, design and decoration of the home environment which had improved since our last inspection to provide colour and contrast with interesting things for people to see.

The provider had made improvements following our previous inspection to ensure people's rights under the Mental Capacity Act were understood and promoted by staff and management.

People had built caring relationships with staff who consistently respected their dignity. Staff knew people well and this had positive benefits of promoting personalised care. Care plans had been developed with people's involvement and accurately reflected their individual needs. People enjoyed the varied things to do for fun and interest so people did not feel socially isolated. The changes in staffing arrangements and culture had supported people in always receiving personalised care which was an improvement achieved since our last inspection.

People who lived at the home and relatives were supported in raising their concerns and complaints. shared concerns with staff and the registered manager. When concerns and complaints had been raised these were effectively responded and resolved to people's satisfaction.

People who lived at the home, relatives and staff were able to offer their views on the care provided through meetings and surveys. The provider and registered manager listened to their concerns and worked to resolve them.

The provider and registered manager had further improved the systems in place, since our last inspection so these were more effective in keeping checks on standards, develop the service and make improvements. During this inspection the registered manager took an open and responsive approach to the issues identified so action was taken to resolve these.

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

The provider of Ravenstone is registered to provide accommodation and nursing care for up to 43 people who have nursing needs. At the time of this inspection 37 people lived at the home. Bedrooms, bathrooms and toilets are situated over two floors with stairs and passenger lift access to the first floor. People have use of communal areas including lounges, conservatory and dining room.

The provider did not have a registered manager in place. 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. A new manager had commenced their employment on 21 June 2017.

Our last inspection took place on 22 and 23 August 2016 where we found the provider was in breach of two regulations. The staffing arrangements did not reduce risks of people care needs being met in a safe and timely way. Staff did not respond to people’s needs in a way which promoted care was centred on their needs to enhance their welfare.

At this inspection we found staffing arrangements were being managed more positively and responses to people’s needs did not significantly impact upon their welfare as at our previous inspection. Although legal requirements had been met in these areas further work was needed to ensure improvements were consistent in how staffing arrangements and care centred on people was responded to so this did not impact upon people’s preferences and individual needs.

People told us they felt safe in the home and staff showed an awareness of how to recognise and report potential abuse so actions could be taken to reduce risks of people being harmed. However, people were not supported by staff to reduce the risks of avoidable accidents when using wheelchairs and in making sure potential environmental hazards had been reduced in a timely manner.

People were confident staff supported them to take their medicines when they needed these so risks to their safety and health was reduced. Where people required time specific medicines staff had prioritised these in line with people’s prescribed health needs.

Staff reflected their skills and knowledge to meet people’s needs in effective ways. The provider had arrangements in place to equip staff with the induction, training and support they required in order to carry out their caring roles. Staff were provided with support during one to one meetings but staff expressed how there were some behaviours within the staff team which required managing as these had impacted upon staff morale.

Staff assisted people with their choices and decisions. There were improved arrangements in place which supported people who lacked the mental capacity to make specific decisions which reflected only people with the legal authority to do so were involved in best interests decisions. Staff had the basic knowledge to inform their practices so people were not restricted unlawfully and staff had knowledge of these so they were able to support people’s safety and meet their needs.

People mostly enjoyed the food which was prepared and cooked. However, for some people there were occasions when they felt unable to eat their meals and enjoy these due to how these were cooked. The former management team had been made aware of this aspect of people’s meal experiences which required improving but no action had been taken to remedy this.

People were supported by the arrangements in place to monitor and identify when people did not eat and or drink sufficient amounts to meet their needs. Healthcare professionals were consulted so staff had the best possible advice and guidance in order to support people to remain healthy and well.

Staff’s caring approaches did not consistently support people in gaining positive care experiences. On occasions this impacted upon the assistance people required to maintain their dignity and privacy.

People had opportunities to have fun and interesting things to do were planned. However, staff missed opportunities to introduce into their caring roles time to spend enhancing people’s social wellbeing and having spontaneous moments of fun.

The provider had a complaints procedure and people believed if they raised any complaints action would be taken to resolve these. Learning would also be taken from complaints made so similar issues were reduced for people.

The management team had arrangements in place to support staff. However, we heard from staff how the inconsistencies in the management of the home had impacted upon staff morale. Staff did not feel wholly supported to work as a team as there were behaviours within the staff team which continued to need improving and managing. Staff were hopeful the new manager would support them in their roles so they were able to provide consistently good quality care.

We found the inconsistencies in management of the home together with the provider's quality checking arrangements had not always been consistently effective in monitoring people's care experiences, and driving through improvement actions in a timely manner.

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

The provider of Ravenstone is registered to provide accommodation and nursing care for up to 43 people who have nursing needs. At the time of this inspection 38 people lived at the home. Bedrooms, bathrooms and toilets are situated over two floors with stairs and passenger lift access to the first floor. People have use of communal areas including lounges, conservatory and dining room.

Since our previous inspection a new manager had come into post in October 2015. The manager had said they would make an application to register with us but at the time of this inspection the application had not been made to us. However, at the time of this inspection the provider was recruiting to ensure they were fulfilling their legal responsibility in having a manager who was registered with the Care Quality Commission. 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 the provider needed to make improvements to ensure people’s needs were effectively met and they were safe. We saw staffing arrangements did not ensure people’s individual needs were met in a timely way which significantly compromised people’s wellbeing and safety. Staff believed they did not have time to spend with people to promote good care.

People’s medicines were stored securely and made available to people as prescribed. Although, we were concerned about two people who did not receive one of their particular medicines at the right time. For one person this had impacted on their emotional wellbeing and health needs.

People had different reasons for feeling safe whilst living at the home which included feeling secure and having staff ‘on hand’ so they could request support. Staff showed a good understanding of how to recognise abuse and how to report if concerns were raised. Staff were aware of how to minimise risks to people’s safety. We saw they used specialist equipment to ensure people’s needs were met and the risks of injuries were reduced.

There were staff recruitment and selection processes in place to make sure the providers recruitment arrangements did not compromise people’s safety. Improvements were being made to ensure all staff had the opportunity of receiving regular training and one to one meetings to support them in their roles. We saw staff did not always apply their knowledge into their daily practices and staff felt unsupported due to the inconsistency in staffing arrangements.

People were asked before support was provided and their wishes were respected. We saw people were given choice about day to day decisions such as what they would like to wear and where they would like to sit. However, there were inconsistencies in assessing people's ability to make their own decisions. Where decisions had been made on people's behalf the records did not always reflect whether best interest decisions were made by people who had the authority to do this.

People were supported to have a choice of meals from the menu which was being developed further. Improvements were being made to provide people with further opportunities throughout the day to boost their calories if their appetites were poor, such as snacks. More consideration was needed to make sure people had the support they required to eat their meals without any unreasonable delays and it was a sociable occasion for people.

Health and social care professionals were involved in people's care to ensure they received the care and treatment which was right for them.

Staff relationships with people were caring and supportive. However, staffing arrangements and the lack of leadership had impacted upon the time staff invested into providing care which was not always led by tasks staff needed to do. There was also little consideration made in how people were supported to maintain their dignity which reflected people were not always placed at the heart of staff practices.

Record keeping required strengthening to ensure people's care and health needs were accurately recorded especially where people’s needs had changed. Work was in progress to update people’s records with people’s involvement so they accurately reflected their individual needs.

Opportunities for people to follow their own interests and socialise was continuing to be embedded into daily life. However, staff missed opportunities to introduce into their caring roles time to spend socialising with people. There was also a culture of people sitting in wheelchairs for long periods of time in communal areas of the home whereby staff could have taken the time to encourage people to sit in armchairs.

The provider had a system in place for dealing with people’s concerns and complaints and these had been followed. However, the opportunities for people to voice their opinions about the quality of the service were informal so it was difficult to see what changes had been made as a result of their feedback.

The provider had management procedures in place to ensure people received safe and effective care. However the service people received was under internal scrutiny by the regional manager to ensure the provider’s required standards were achieved and people received high quality care.

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

People were positive about life at the home. One person said "It is excellent here, like home from home. I feel safe and am extremely happy here.' Another person told us: 'I think it is (the care) good' and 'Very happy with what goes one here.'

During our inspection we saw that staff helped people to make simple everyday decisions, such as, what they wanted to drink and what they wanted to do. There were some arrangements in place where required, to help people with the bigger decisions so that their best interests were upheld.

We saw that people who lived at the home had their medicines as prescribed at the right time and in the right way. This made sure people's health needs were effectively met.

The manager had responsive systems in place to monitor and review people's experiences and complaints to ensure improvements were made where necessary. All the people that we spoke without exception told us that the management team and staff were approachable and for this reason they felt comfortable to complain if they needed to.