Archived: Ravenswood Care Home

Ravenswood Care Home is a residential care home providing personal and nursing care to 36 people aged 65 and over at the time of the inspection, some of whom were living with dementia. The service can support up to 55 people across one adapted building.

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

People’s care plans were not always reflective of their current needs. The design of the building was not always adapted to meet people’s needs. Staff did not always receive specialist training to meet people’s individual needs. People were not always supported with their diet and nutrition. Effective systems were not always in place to assess and manage risk to people’s safety. Systems in place were not always effective in identifying areas to improve on people’s care. Managers and staff did not always understand their roles, responsibilities and requirements.

People’s medicines were mostly managed effectively. The manager was addressing older areas of the building which required redecorating in order to help keep them clean. Accident and incidents were recorded and reviewed. People were supported by enough staff who supported them in a timely manner and staff members received training on how to keep people safe from the risk of abuse.

Staff worked in partnership with other healthcare professionals and people had access to healthcare services when required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We found there was a positive culture shared between staff to promote good outcomes for people. Incidents were investigated and improvements were made. Managers and staff were open and honest. People, their relatives and staff had the opportunity to make changes to the service.

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 requires improvement (published 15 August 2019).

Why we inspected

The inspection was prompted in part due to concerns received about people’s needs not being met, staff shortages and poor infection control. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements in relation to people’s care plans and governance systems in place. Please see effective and well-led sections of this full report.

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 coronavirus and other infection outbreaks effectively.

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

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.

Ravenswood Care Home is a residential care home providing personal and nursing care to 29 people aged 65 and over at the time of the inspection. The service can support up to 55 people in one adapted building.

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

Improvements were needed to ensure there were systems in place to monitor all areas of people’s care needs and to ensure the improvements made were imbedded and sustained. Records were in the process of being updated to ensure they reflected people’s preferences in the way they wished their care to be provided.

Improvements were still needed to ensure medicines were managed and staff were deployed across the service effectively. Improvements to the design of the service were in progress to ensure the environment met the needs of people.

People were supported by safely recruited staff who had the skills and knowledge to provide safe and effective support. People were supported by staff that understood their responsibilities to safeguard people from the risk of harm. There were systems in place to ensure lessons were learnt when things went wrong.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s nutritional risks were monitored, and advice was sought from healthcare professionals to maintain people’s health and wellbeing.

People were supported by caring and compassionate staff that supported people with patience. People’s choices were respected in line with their individual communication needs to promote informed decision making. People’s right to privacy was up held and their independence was promoted.

People had the opportunity to be involved in interests and hobbies. People understood how to make a complaint and there was a system in place to investigate and respond to complaints received. The manager was in the process of gaining people’s end of life wishes to ensure their preferences were respected at this time of their lives.

Improvements had been made to the management of the service. The manager promoted an open culture within the service where feedback was gained from people, relatives and staff. The management team had a clear plan in place to continue to implement changes at the service to improve people’s care.

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 (report published 07 March 2019) and there were multiple breaches of regulations.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. We received a monthly update of their progress against the action plan.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 06 March 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

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.

At this inspection in January 2019, we found the provider had not taken measures to comply with the regulations or the terms and conditions of their registration.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

This inspection was unannounced and took place on 24 January 2019.

Ravenswood Care Home 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.

Ravenswood Care Home accommodates 55 older people some of whom were living with dementia. On the day of our inspection 35 people were living in the home. The home is situated on two floors and was accessible to people who used a wheelchair.

The home had a registered manager who was present on the day of our inspection visit. 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.

The management of medicines continued to be unsafe and people did not always receive their medicines in line with their prescription. People were at risk of potential abuse because safeguarding protocols were not followed to safeguard them.

Where accidents had occurred, lessons were not learned and measures were not taken to reduce the risk of them happening again. People were not assisted to access treatment and this placed their health at risk. Staff were not always available to support people in a timely manner and this meant some people were left in discomfort.

People did not have the opportunity to make decisions about their care and treatment and this meant they were at risk of not receiving a service that met their preferences. Some people did not have access to healthcare services when needed which, compromised their health and wellbeing. Staff were unskilled in some areas of care delivery that was specific to the needs of people using the service. Equipment was not always put in place to ensure people’s needs were met. The provider did not always work jointly with other agencies to ensure people's assessed needs were met safely.

Equality, diversity and human rights had not been explored or imbedded in the service provided so people could not be assured their specific needs would be recognised or met. People could not be confident the care and support provided to them at the end of their life would meet their wishes because this had not been discussed with them.

The provider’s governance continued to be ineffective to assess, monitor and drive improvements and placed people at risk of unsafe care and treatment. The registered manager did not always comply with the terms and conditions of their registration by reporting significant events to us which they are required to do by law.

Systems and practices were in place to reduce the risk of cross infection. Although safeguarding protocols had not been followed, people told us they felt safe living in the home. People told us that their right to privacy was respected by staff.

People were supported to pursue social activities. Relatives were able to visit the home at any time and were made to feel welcome by staff. People felt confident to share their concerns with the staff and the registered manager.

People were provided with a choice of meals and had access to drinks at all times.

At the last inspection on 31 July and 1 August 2017, we asked the provider to take action to make improvements to meet regulations 9, 10, 11, 12, 13, 14, 16, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found the provider had made some improvements so they were no longer in breach of Regulations 9, 10, 11, 13, 14, 16 and 19. They were in continued breach of regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

There was no registered manager in post. There was a manager in post; however they had not undertaken the registration application at the time of our 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.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The number of staff had improved since our last inspection. However people did not always have their needs met in a timely way as staff were not always deployed effectively. This meant people could not always be treated with compassion due to a delay in them getting support.

Medicines were not always stored and administered as prescribed and there were gaps in the recording regarding medicines.

Risks to people’s health and wellbeing were not always assessed and planned for, such as agitation, health conditions and following falls, leaving people at risk.

The provider did not have effective systems in place to ensure people received the care and support they needed. The provider did not always take action to make required changes when incidents occurred.

Staff understood their safeguarding responsibilities and appropriate referrals had been made. However, one incident had been documented by staff but had not been reported by management.

Decision-specific mental capacity assessments needed to be put into place and best interest decisions clearly recorded.

Staff training had improved although further improvements were required. We have made a recommendation about staff continuing to receive updated training so all training is up to date and that staff understand what the MCA means for people they support.

The home had improved in appearance but further improvements could be made to ensure it was dementia friendly.

Care plans were not always updated following a change in people’s needs so staff did not always have up to date guidance.

Plans for when people were coming towards the end of their life had been considered. We have made a recommendation that the service consistently reviews and records people’s wishes in relation to their end of life support preferences.

More activities were now available for people, although it was felt more time for staff to engage with people would be beneficial.

An Equality and Diversity Policy was in place, however people had not always been given the option to discuss their sexuality, if those chose to.

Infection control measures were in place and the home was clean with no malodours.

People had a choice and were provided food and drink appropriate for their needs.

People had access to other health professionals and a multidisciplinary team meeting was established with other organisations in order to work more effectively.

People and relatives told us and we observed interactions whereby people were treated with respect. People told us they were encouraged to be independent.

People were offered choices about their care, such as what food to eat and where they would like to spend their time. Visitors could also visit when they chose.

Complaints were recorded and responded to in line with the provider’s policy.

People and relatives had more opportunities to feedback about the service and action plans were shared so relatives were kept up to date with changes.

Professionals we spoke with felt the service worked in partnership with them and the consultant and new management team regularly kept in touch with other stakeholders, such as the CQC and the local authority.

At the last inspection on 22 February 2017, we asked the provider to take action to make improvements to meet regulations 10, 12, 13, 17 and18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of Care Quality Commission (Registration) Regulations 2009. At this inspection we found the provider had not made the required improvements and there had been further deterioration in the quality of the care people received.

There was no registered manager in post. There was a manager in post; however they had not undertaken the registration application at the time of our 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.

During this inspection we identified nine breaches of the Health and Social Care Act 2008. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore remains in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

People did not always have their needs met, because there was not enough staff to meet people’s needs. Where people were at risk, staff did not understand how to manage the risks to keep people safe. People did not always receive their medicines safely. Medicines were not always available to people. People were not protected from the risk of abuse. Staff did not always identify potential abuse, which meant incidents were not investigated and reported to the local safeguarding authority.

People received support from staff that did not have the knowledge to support people safely. We found not all staff understood how to provide some aspects of people’s care. People were not always supported in a way that protected them from unlawful restrictions. People did not always have their food and fluid intake managed safely. Staff did not always make sure people had enough to eat and drink. Staff did not always seek support for people from health professionals when they needed it.

People did not have their privacy and dignity respected. People were not involved in making decisions about their care and support. People did not have meaningful relationships with staff. Although some staff were seen engaging with people positively, most staff were too rushed to speak with people and sometimes missed the opportunities for interaction.

People’s needs and preferences were not understood by staff. People did not receive the care and support they needed. Staff did not always understand people’s needs and preferences. People had access to group activities, but there was little evidence of people being able to follow their individual interests. People’s complaints were not always responded to in a timely manner and action was not always taken to resolve people’s concerns.

The provider did not have systems in place to ensure people received the care and support they needed. The provider had failed to monitor the quality of the service and ensure people were protected from harm. The provider did not always take action to make required changes when incidents occurred.

The inspection took place on 22 February and 24 March 2017and was unannounced. Ravenswood Care Home is a residential home for up to 55 older people. There were 52 people living at the service at the time of the inspection. People who used the service were older people and may have had physical and/or mental health needs.

At our previous inspection in October 2016, we found there were concerns about staffing levels and there was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It was also identified that audits were not always being carried out. We asked the provider to tell us how they were going to make the required improvements.

There was a Registered Manager in post at the time of our 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.

At this inspection we identified multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. One of these breaches was an on-going breach identified in the last inspection in relation to staffing levels. There was also a breach a breach of Care Quality Commission (Registration) Regulations 2009.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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 not always enough staff available to keep people safe and meet people’s needs. Communal areas were often left unattended which left people at risk of harm to their health, safety and wellbeing.

Plans were not always in place to support people if they became agitated. Staff were also not trained to support people effectively who were experiencing periods of agitation.

Plans were also not in place for people who needed support with their skin integrity and we could not be sure that people were receiving the level of support required to look after their pressure sores.

Risk assessments and detailed plans were not always in place to prevent people from falling and if people had fallen, action was not always taken to support people from falling again and some people had continued to experience falls.

We could not be sure that people were receiving their topical medicines as prescribed. Some risks to people’s safety had not been taken into consideration, such as access to some medicines.

Effective systems were not in place to protect people from the risk of abuse. Potential abuse was not always reported to the local authority as required.

Equipment was not always fit for purpose and unsafe equipment was accessible for people to use.

Staff training was not always effective. For example, we saw staff use unsafe methods to support people to move.

The principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were not always followed as required by law.

People were not always supported to have food and drinks that were appropriate for their needs and there were mixed reviews about the food.

The environment was not always dignified. Some areas of the home had unpleasant odours and bathrooms were not always welcoming and tidy to promote dignified care.

Staff were sometimes not respectful and responsive to people’s needs. However, we did see some caring interactions between staff and people.

Care plans were not always personalised and did not always contain accurate and up to date information about people and their care preferences. This put some people at risk of not having their needs met or not having their preferences catered for as there was limited information available for staff.

Complaints were documented and responded to and people generally felt able to complain about their care however feedback was not always acted upon.

Audits of accidents and incidents or care plans had not been taking place so omissions in care had not been identified. Medicine audits were in place however these had not identified concerns relating to topical medicines.

The registered manager had not always submitted notifications to us which they are required to do so by law.

Although people who could partake in activities independently were observed carrying out their hobbies on the day of inspection, most people watched TV for the day.

On the days of the inspection, the staff did not have time to support people to participate in activities that were meaningful to them or therapeutic.

Safe recruitment practices were in place and staff had appropriate checks prior to starting work to ensure they were suitable to work with people who use the service.

This inspection was completed on 11 October 2016 and was unannounced. Ravenswood Care Home provides personal care and accommodation for up to 55 older people, some of whom may be living with dementia. At the time of the inspection 52 people were using the service. The service had 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 were at risk of not getting the support they required in a timely manner as at times, there were insufficient staff to meet their needs. We found that, at times, people had to wait to have their care and support needs met and that staff were unable to spend quality time with people.

People gave us mixed reviews about the activities available to them in the service, and expressed wishes to be able to access the community more often.

Quality assurance audits were not always undertaken effectively to identify any trends in incidents.

People were referred to relevant health professionals when they needed it and were supported to maintain a healthy diet. People’s medicines were stored and administered safely by trained staff.

People were provided with enough food and drink to maintain a healthy diet. People had choices about their food and drinks and were provided with support when required to ensure their nutritional needs were met. People's health was monitored and access to healthcare professionals was arranged when required.

People were treated with kindness and compassion and they were happy with the care they received. People were encouraged to make choices about their care and their privacy and dignity was respected.

People knew how to complain and told us they were confident issues would be addressed. People and their relatives were encouraged to give feedback on the care provided. The registered manager and provider responded to feedback and changes were made to improve the quality of the service provided.

Staff knew what to do if they suspected a person had been abused. The manager reported incidents of suspected abuse to the local authority for further investigation.

Safe recruitment procedures were followed to ensure that new prospective staff were fit to work with people.

The registered manager understood the conditions of registration with us. We saw that systems were in place to monitor quality of the service; however some incidents were not being assessed for trends to identify areas for improvement. People at the service felt the registered manager was approachable.

We spoke with two relatives during our inspection and reviewed 16 comment cards.

People were treated as individuals and care was provided with dignity, respect and compassion. A relative told us, 'There is a wonderful caring atmosphere here where you feel your family member is safe and secure'.

We saw that staff did not always seek specialist advice and support to maintain people's physical and mental health with the urgency required to keep people safe.

Staff had received training in the care of people with dementia. Staff we spoke with were able to explain the different types of dementia and knew the needs of the people they cared for well.

Staff felt well supported by the manager. A member of staff told us, 'It's much better here since X started'.

A relative told us, 'During the last 12 months the care has improved greatly. The staff spend more time with people. I also receive feedback from the staff about my family member'.

The registered manager had put effective systems in place to monitor the quality of service and make improvements when necessary.