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Ralphland Care Home Inadequate

We are carrying out a review of quality at Ralphland Care Home. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 24 September 2019

During a routine inspection

Ralphland is a residential care home providing accommodation and personal care to older people, some of whom are living with dementia. The service can support up to 39 people. At the time of this inspection there were 34 people living at the service, which is provided over three floors in one adapted building

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

There were significant and widespread shortfalls in the governance of the service. The provider and managers had failed to identify issues we found including with health and safety and record keeping, including risk assessments. The leadership was weak, inconsistent and overbearing. Systems were ineffective in driving improvements and high quality care. The provider had failed to act on concerns identified during our inspection. This left people at risk of harm.

People were at risk of avoidable harm because risks were not recorded accurately, monitored or managed. We raised a safeguarding concern for one person who was at risk of choking, as we could not be sure this had been managed appropriately.

Health and safety was not well managed. This put people at risk of potential harm. We contacted the fire service, who attended the home and introduced measures to reduce the risk of harm to people in a fire situation. These were implemented with immediate effect. No control measures had been introduced following positive samples of legionella being found in the service.

Good outcomes were not always achieved for people living at the service. People were at significant risk of dehydration due to their low fluid intake. The environment was not suitable for the needs of people living there. Access to communal areas was limited.

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.

Staff did not always understand people’s care needs. They had not received sufficient training or support to equip them for their roles and responsibilities.

Care was provided in task-centred, institutionalised ways. Little consideration was given to people’s wellbeing or emotional needs. People were not always treated with dignity and respect; they were not able to have privacy in their bedrooms. People’s independence was not promoted.

People did not receive responsive care. When assistance was requested there were delays in this being provided, which caused people discomfort. People were socially isolated, with no access to the wider community.

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

Rating at last inspection

The last rating for this service was good (published 10 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified multiple breaches in relation to safe care and treatment, fit and proper persons employed, person-centred care, staffing, dignity and privacy, premises and equipment, need for consent and good governance.

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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 improvem

Inspection carried out on 6 January 2017

During a routine inspection

This was an unannounced inspection carried out on 6 January 2017.

Ralphland Care Home can provide accommodation and personal care for 39 adults of all ages including people who live with dementia and/or who have a physical disability. There were 37 older people living in the service at the time of our inspection half of whom lived with dementia.

The service was operated by a company who was the registered provider. The registered provider had appointed a business manager. They were based in the service and dealt with financial and administrative matters. There was also an acting manager and they were responsible for supervising the care provided in the service. The acting manager had applied to be registered by 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. In this report, when we speak about the company who ran the service we refer to them as being, ‘the registered person’.

Staff knew how to respond to any concerns that might arise so that people were kept safe from abuse including the risk of financial mistreatment. People had been helped to avoid the risk of accidents and medicines were safely managed. There were enough staff on duty and most of the necessary background checks had been completed before new staff were appointed.

Staff knew how to care for people in the right way and they had received most of the training and guidance they needed. People had been assisted to eat and drink enough to stay well and they had been supported to receive all of the healthcare assistance they needed.

The acting manager had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the acting manager had taken the necessary steps to ensure that people only received lawful care that respected their rights.

People were treated with kindness and compassion. Staff recognised people’s right to privacy, promoted their dignity and respected confidential information.

People had been consulted about the care they wanted to receive and they had been given all of the assistance they needed. Staff promoted positive outcomes for people who lived with dementia. Although some people wanted more support to go out into the community most people were satisfied with the hobbies and interests they could enjoy. There was a system for quickly and fairly resolving complaints.

People had been consulted about the development of the service and quality checks had been completed. The service was run in an open and inclusive way so that good team work was promoted. Staff were supported to speak out if they had any concerns and people had benefited from staff acting upon good practice guidance.

Inspection carried out on 29 October 2014

During a routine inspection

Ralphland Care Home provides accommodation for up to 37 people who need support with their personal care. The service provides care for older people and people who are living with dementia. The accommodation is arranged over two floors and there is a passenger lift to assist people to get to the upper floor.

There were 33 people living in the service at the time of our inspection.

This was an unannounced inspection carried out on 29 October 2014. There was a 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.

We last inspected Ralphland Care Home in October 2013. At that inspection we found the service was meeting all the essential standards that we assessed.

People said that they felt safe in the service and that they received all of the care they needed. They had received a wide range of personal care such as help with washing and dressing, using the bathroom and moving about safely.

People and their families had been included in planning and agreeing to the care provided. People had an individual care plan, detailing the assistance they needed and how they wanted this to be provided.

Staff knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

People were treated with kindness, compassion and respect. Staff took time to speak with the people they were supporting. People enjoyed talking to staff and were relaxed in their company. Staff knew how to support people who lived with dementia.

Medicines were safely managed.

People were provided with a range of meals that they enjoyed.

People were offered the opportunity to pursue their interests and hobbies.

During a check to make sure that the improvements required had been made

People were protected against the risks of unsafe or inappropriate care and treatment because records were accurate in relation to the care and treatment for people.

Inspection carried out on 26 June 2013

During a routine inspection

During our visit we spoke with three people, two staff and a relative. We observed the care people received and looked at records.

During our visit we looked particularly at areas where concerns had previously been raised. For example the transfer of people to hospital and administration of medicines. We found medicines were administered and stored safely. We saw the home had in place procedures for transferring people and when we looked in the records found they had been followed.

Overall we observed people were supported by skilled and experienced staff who understood their roles and responsibilities.

We observed care and saw staff were responsive to people and interacted with them positively.

We spoke with a relative. They told us the staff were pleasant but very busy at times. They said they felt confident with the care their relative received.

People told us the staff were caring and looked after them well.

We observed staff offering activities to people. For example we observed a member of staff reading a magazine with a person.

We saw staff explained the care they were giving to people. For example when they offered medicines to people they explained what they were.

When we looked at the records we found there were gaps and they did not accurately reflect the care people were being given or required.

Inspection carried out on 6 November 2012

During a routine inspection

We spoke with five people who used the service. They told us they were well looked after and staff were caring. One person told us, �It�s very good here, staff are all very kind.� Another person said, �Very satisfied with all aspects of the care, can�t fault them.�

We saw people were supported to make choices and decisions about their lifestyles, and they were treated with dignity and respect.

We found people were supported to eat and drink sufficient amounts to meet their needs. People had a choice of food which took account of their individual preferences, needs and cultural requirements. One person said, �The food is lovely, they cook things how I like.�

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Throughout our inspection we observed good interactions and found people who used the service were relaxed and happy in the care of the staff.