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Ravenswing Manor Residential Care Home Good

Reports


Inspection carried out on 17 April 2019

During a routine inspection

About the service

Ravenswing Manor Residential Care Home, provides personal care and support for up to 24 people. At the time of the inspection, there were 20 people living in the home, most of whom were living with dementia. The service does not provide nursing care.

The care home is an extended, detached older style property with a stair lift access to the first floor.

People’s experience of using this service

People were happy about the way the home was managed and were complimentary about the registered manager and staff. The registered manager considered the views of people, their relatives and staff about the quality of care provided. The registered manager used the feedback to make improvements to the service.

People told us they felt safe and staff were kind and caring. The provider had safeguarding adults’ procedures and staff understood how to protect people from abuse. Recruitment processes ensured new staff were suitable to work in the home. There were sufficient numbers of staff deployed to meet people's needs and ensure their safety. People received their medicines when they needed them from staff who had been trained and had their competency checked. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. The registered manager was aware further detail was needed in some assessments to ensure staff had appropriate guidance to manage risks. People were protected from the risks associated with the spread of infection. The home was clean and odour free.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s care and support needs were assessed prior to them using the service. The provider had arrangements in place to ensure new staff received induction training. Staff received ongoing training, supervision and support. People enjoyed the meals and were supported to eat a nutritionally balanced diet. People had access to various healthcare professionals, when needed.

Staff treated people with care, kindness, dignity and respect and spoke with people in a friendly manner. Staff knew about people backgrounds and about their routines and preferences. Whilst people received the care they needed and wanted, we found the care plans did not always fully reflect the care given or what staff knew about people’s likes and dislikes; the registered manager agreed to review this. People, where possible, had been consulted about their care needs and had been involved in the care planning process.

People told us they enjoyed the activities and records showed a range of activities had been provided. People were aware of how they could raise any complaints or concerns if they needed to and had access to a complaints procedure. The registered manager was aware the complaints information needed to be reviewed to reflect the correct contact information for local agencies.

Rating at last inspection

At the last inspection, the service was rated Requires Improvement (published 16 April 2018).

Why we inspected

This was a planned inspection based on the previous rating. At our last inspection of February 2018, we found a breach of regulations as the quality assurance processes were not effective in identifying shortfalls. Following the inspection, the provider sent us an action plan advising how the service would be improved. During this inspection, we found sufficient improvements had been made. The registered manager was monitoring all aspects of the service and appropriate action had been taken to address any shortfalls.

Follow up

We will continue to monitor the service to ensure that people receive safe and high-quality care. Further inspections will be planned for future dates.

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

Inspection carried out on 26 February 2018

During a routine inspection

This inspection took place on 26 and 27 February 2018. The first day of the inspection was unannounced. The service was last inspected in October 2015 when it was rated Good.

Ravenswing Manor 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. The care home is a detached property and accommodates up to 24 older people on two floors. At the time of the inspection there were 22 people accommodated in the home.

The home had 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.

During this inspection we identified one breach of regulations. This was because the systems and processes to monitor the quality and safety of the service were not sufficiently robust; this had led to the shortfalls we identified during this inspection. You can see what action we told the provider to take at the back of the full version of the report. This is the first time the service has been rated as Requires Improvement.

We found a number of concerns regarding food safety and the safety of equipment. A number of out of date food items were stored in the fridge and the stair lift had not been serviced in line with required timescales. The registered manager had failed to notice or take action in relation to these concerns.

Records showed that fire safety training had not taken place in the service since September 2016; the registered manager could not explain why this was the case. Following the inspection we were told this training had been arranged for all staff in March 2018.

Although regular care plan audits had taken place, we found two people’s care records did not contain risk assessments in relation to the way their medicines were sometimes administered, i.e. in food or drink without the person’s knowledge. One person’s care records did not contain a risk assessment in relation to how staff should manage the fact they were experiencing a bacterial infection; this meant there was a risk of cross infection. All of these risk assessments were put in place by the end of the inspection.

Although people who lived in the home did not raise any concerns about staffing levels, all the staff spoken with told us they needed an additional staff member each day, particularly in the morning; this was to help ensure people’s needs were always met in a timely manner. The registered manager told us they would discuss the need for additional staff member with the provider.

Staff spoken with told us that they had completed training relevant to their role. Records we reviewed showed staff received regular supervision and an annual appraisal of their performance; these arrangements help to ensure staff have the required knowledge and skills in order to provide safe and effective care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Systems were in place to help ensure people’s health and nutritional needs were met. Although there was no chef in place and meals were prepared by certain care staff with appropriate training, people told us the quality of food was generally good.

People’s health and communication needs were clearly documented within their care records. Staff worked in partnership with a number of health professionals to help ensure people had access to appropriate healthcare services.

People told us staff were kind, caring and respectful of their dignity and privacy. We noted policies for th

Inspection carried out on 10 September 2015

During a routine inspection

This was an unannounced inspection which took place on 10 September 2015. We had previously inspected this service in April 2015 when we identified eight breaches of the Health and Social

Care Act 2008 (Regulated Activities) Regulations 2014. This resulted in us serving three warning notices and making five requirement actions. As a result of our inspection findings the service was placed into ‘Special measures’.

Following the inspection in April 2015 the provider wrote to us to tell us the action they intended to take to ensure they met all the relevant regulations. This inspection was undertaken to check the required improvements had been made.

We found the service had made significant improvements since our last inspection and all regulations we inspected were being met. As a result the service has been removed from ‘Special measures’.

Ravenswing Manor Residential Care Home is registered to provide accommodation for up to 24 older people who require support with personal care needs. At the time of our inspection there were 20 people using the service.

There was no registered manager in place at Ravenswing Manor. The manager who was responsible for the day to day running of the service was in the process of completing the necessary training to register as manager for the service. 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 we spoke with told us they felt safe in Ravenswing Manor. Staff had received training in safeguarding adults and were able to tell us of the correct action to take if they witnessed or suspected abuse.

Staff were safely recruited. Although we observed there were enough staff on duty on the day of the inspection, some people told us they considered staffing levels needed to be increased at times.

People spoke positively about the caring nature of staff. During the inspection we noted positive interactions between staff and people who used the service. All the staff we spoke with demonstrated a commitment to providing person-centred care.

Staff had received the induction, training and supervision required to ensure they had the skills and knowledge needed to carry out their role effectively. Staff told us they enjoyed working in the service and received good support from senior staff. They told us the atmosphere in the service had improved since our last inspection.

Although improvements had been made in the way medicines were managed in the service, we noted cream charts were not always fully completed. This meant we could not be certain people had always received their creams as prescribed.

All areas of the home were clean and well maintained. Procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply. However, recent fire checks had noted that some fire doors were not closing properly and we could not find any evidence to confirm that required remedial action had been carried out. This meant some people might not be fully protected in the event of a fire.

People’s care records contained good information to guide staff on the care and support required. People told us they always received the care they needed. The care records showed that risks to people’s health and well-being had been identified and plans were in place to help reduce or eliminate the risk.

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

We found the meals provided in Ravenswing Manor were varied and nutritionally balanced. Systems were in place to help ensure people’s health and nutritional needs were met. People told us they enjoyed the food provided in the service.

People were supported to access health care services when necessary. Improvements had been made to recording systems in the service to help ensure any advice given by health care professionals was always documented and acted upon.

A programme of activities had been introduced at Ravenswing Manor to help improve the well-being of people who used the service. We noted plans were in place to organise events in the home and to support people to attend local community resources.

Records we reviewed showed people who used the service and their relatives had opportunities to comment on the care provided in Ravenswing Manor. We saw evidence that suggestions made had been acted upon. Systems were also in place to investigate and respond to any complaints people might make. People told us they would feel confident to raise any concerns they had with care staff or the manager.

Significant improvements had been made to the quality assurance processes in place in the service. The manager had introduced a series of weekly and monthly checks and was motivated to continue to drive forward improvements in the service. All the people we spoke with made positive comments about the leadership displayed by the manager and the improvements they had made since the last inspection.

Inspection carried out on 8 and 15 April 2015

During a routine inspection

This was an unannounced inspection which took place on 8 and 15 April 2015. We had previously inspected this service in May 2014 when we found it was meeting all of the regulations we reviewed.

Ravenswing Manor Residential Care Home is registered to provide accommodation for up to 24 older people who require support with personal care needs. At the time of our inspection there were 19 people using the service.

There was a registered manager in place at Ravenswing Manor. 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 identified eight 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.

Although people told us they generally felt safe in Ravenswing Manor we found systems for identifying and reporting safeguarding concerns needed to be improved in order to ensure people who used the service were protected from abuse.

People who used the service told us staffing levels needed to be improved. We found the arrangements for staffing at night failed to ensure people were provided with safe and effective care. Recruitment systems were not sufficiently robust to protect people who used the service from the risk of unsuitable staff. Staff had also not received the necessary induction, training, supervision or appraisal to help ensure they were supported to deliver effective care.

We received positive feedback about the attitude and approach of staff from people who used the service and their relatives. People who used the service told us staff respected their dignity and privacy and supported them to maintain their independence as much as possible. Our observations during the inspection showed that staff were mostly caring and reassuring in their interactions with people in Ravenswing Manor.

Systems for the safe administration of medicine needed to be improved to ensure people always received their medicines as prescribed.

Although staff had not received specific training in the Mental Capacity Act 2005 or the Deprivation of Liberty Safeguards (DoLS) they were able to tell us how they supported people to make their own decisions. People who used the service told us staff mainly respected their choices and they were not subject to any restrictions in Ravenswing Manor. The registered manager told us they were aware of the action they should take to ensure any restrictions assessed as necessary for individuals who used the service were legally authorised.

We found care records were not always fully completed. This meant there was a risk people might not receive the care they required. People who used the service told us they had limited opportunities to comment on the care they received or the quality of care provided in Ravenswing Manor. We noted no resident meetings had taken place since the service opened in 2013 although the registered manager told us they spoke regularly with all the people who used the service and their relatives.

People who used the service told us there was a lack of activities provided for them. Although on the first day of the inspection we saw staff supported a small group of people who used the service to reminisce about past events using family photographs, there was no evidence that a regular programme of activities was in place in Ravenswing Manor.

We found the system for identifying, recording, investigating and responding to complaints needed to be improved. Quality assurance systems were also not effective in identifying where improvements needed to be made to the service.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

  • Ensure that providers found to be providing inadequate care significantly improve
  • Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
  • Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Inspection carried out on 20 May 2014

During a routine inspection

The inspection team included an inspector and an expert by experience. The team gathered evidence against the outcomes we inspected to help us answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive to people's needs? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with eleven people who used the service and five relatives. We also spoke with a professional visitor, three staff members and looked at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We spoke with eleven people who used the service. They told us they felt safe in Ravenswing Manor and were happy with the care provided. Comments people made to us included, �This is the best home I�ve been in� and �They [the staff] can�t do enough for you�.

Care records provided staff with good information about the individual needs of people. Information included areas of risk and what staff would need to do to keep people safe.

People had their medicines at the times they needed them and in a safe way.

Is the service effective?

People were assessed by the manager from the home before they were admitted to ensure their individual needs could be met.

To ensure that safe and effective care was provided, staff continued to update their skills and knowledge with regular training and updates.

Specialist dietary, mobility and equipment needs had been identified in care plans where required. Risk assessments were regularly reviewed and care plans amended to reflect people�s changing needs.

Is the service caring?

People we spoke with were complimentary about the staff and the care provided. They told us, �You can tell that she [staff member] is doing the job because she cares� and �Staff are excellent�.

It was clear from our observations and discussions with staff that they knew people well and had a good understanding of their care and support needs.

Is the service responsive to people's needs?

Information in the care records showed that the staff at the home involved other healthcare professionals in the care and support of people who used the service.

People knew how to make a complaint and were confident any concerns they raised would be dealt with by the home manager. One person told us, �I have no complaints. We have nothing to grumble about.�

Systems were in place to ensure staff had access to up to date information regarding people�s needs. This should help ensure they were supported to respond appropriately to any changes to a person�s condition.

Is the service well-led?

The home had a manager who was registered with the Care Quality Commission and was qualified to undertake the role. People we spoke with on the day of our visit were very complimentary about the manager. Comments made to us included, �The manager is good. She knows her job. She�s always asking us how we are doing and if we need anything� and �She [the manager] is wonderful. She does things immediately.�

Staff told us they felt well supported by both the manager and the owner of the service and were always able to raise any issues of concern with them.

There were a number of quality assurance systems in place to ensure people were cared for safely. Feedback was sought from people who used the service and visitors through questionnaires, asking for their views on the care and facilities provided. Comments we saw on the most recent questionnaires included, �I couldn�t have come to a better place� and �I can�t say enough good things about everybody; they have been so caring, helpful and nice�.