Ravensworth Lodge

Ravensworth Lodge is a residential care home providing regulated activity of personal care to up to 24 people. The service provides support to older people. At the time of our inspection there were 21 people using the service.

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

People did not always receive care and support to meet their assessed needs in a timely manner. Staff were working without sufficient support and guidance due to a lack of appropriate management support. Processes to ensure enough suitably trained staff were always on duty were not effective. Due to a lack of appropriate management of the service, staff did not receive appropriate checks, support and supervision to carry out their roles effectively.

The provider did not have oversight to ensure staff and health professionals had access to complete care records and up to date policies and procedures. There was no manager oversight to ensure new electronic care recording processes in place for staff to use remained effective, putting people at risk from harm. Information used to manage the risks was not robustly completed. For example, checks to keep people safe during a fire were not completed as required.

People were at risk from otherwise avoidable harm. Staff told us they were not confident in the processes in place to raise any concerns internally for further investigation. There was no clear process for staff to follow to ensure accidents, incidents and safeguarding concerns were recorded and reported as required to keep people safe. We were unable to check all required actions had been completed as the provider had failed to ensure all notifications had been submitted to the CQC as required.

There was no clear strategy in place at provider level to manage the service and no operational plan that ensured the service remained legally compliant with required regulation. The provider had failed to display CQC performance ratings both in the home and on their website. Provider oversight had failed to ensure appropriate checks were completed or reviewed to ensure systems and processes remained effective. We found a range of quality assurance audits had not been completed to check the service since January 2022.

Processes in place to ensure people lived in a clean environment and were protected from the risks of air born viruses were not robust. Where people were incontinent, insufficient numbers of staff meant people were not always assisted in a timely way as required. Deep cleaning of 3people’s carpeted rooms failed to ensure they remained free from the smell of urine and there was no plan in place to implement remedial actions for improvement.

People told us they received their medicines safely. However, checks were not completed that ensured the safe management of medicines followed best practice guidance.

People told us they felt safe and were happy with their care. Staff were knowledgeable and skilled. People received support from a range of health professionals when required. Observations and feedback confirmed the failings we found had a low impact on people at the time of the inspection, but people were at risk if continued.

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.

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 good (published 21 March 2019).

At our last inspection we recommended the provider developed more robust systems to record and analyse accidents and incidents and improved their policy regarding medicines administration. At this inspection we found further improvements were required.

Why we inspected

We received concerns in relation to the management of the home, provider oversight, management of risks and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to the management of the service, provider oversight (including risk management and governance checks), quality assurance, staffing and recruitment.

We have made recommendations for the provider to review and improve their policy and practice for infection prevention and medicines control and the reporting of accidents incidents and safeguarding.

Please see the action we have told the provider to take at the end of this report.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

All essential visitors had to wear appropriate personal protective equipment (PPE). Also, have a negative COVID-19 test result and carry out hand hygiene prior to entering the home.

People were supported to keep in touch with their relatives. Relatives could visit using the indoor visiting room with robust cleaning procedures in place. For people whose relatives couldn’t visit other options were available such as using technology for video calls.

The home had ample supplies of appropriate PPE which was stored hygienically and kept safe. Staff were provided with appropriate areas to put on, take off and dispose it safely. Staff completed online training including putting on and taking off PPE, hand hygiene and other IPC and COVID-19 related training and updates.

Social distancing practices were in place at the home, staff took breaks separately and when people used communal areas such as dining rooms and lounge areas, they were able to share these spaces safely.

The home was very clean and additional cleaning of all areas and frequent touch surfaces was in place such as handrails, handles and keypads. These were carried out and recorded regularly by housekeeping staff. Additional deep cleaning was also carried out where required.

The registered manager had quality systems in place to check the home was providing safe care. There was robust communication system in place including extra staff meetings and handovers for information sharing.

Staff supported people’s social and emotional wellbeing by offering meaningful activities. Staff were also supported with their wellbeing by the provider and registered manager.

People’s experience of using this service: Staff were kind, caring and attentive to people’s needs. People consistently told us they felt safe and praised the care staff provided. Staff treated people with dignity and respect.

The environment was homely and welcoming; there was a positive atmosphere and community amongst the staff and people who used the service. Regular meaningful activities were on offer for people to join in.

Improvements were needed to make sure medicines were managed safely, and to ensure risks were consistently assessed and managed.

We have made a recommendation about developing more robust systems to record and analyse accidents and incidents.

People were kept safe by staff who were trained to recognise and respond to safeguarding concerns. Enough staff were on duty to safely meet people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered manager agreed to develop the policies and systems in the service to support good practice in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

A varied choice of meals and snacks were available. Staff monitored people’s weights and provided help when needed to make sure people ate and drank enough.

Staff received regular training, supervisions and an annual appraisal of their performance. Staff provided effective care; they were confident in their knowledge and skills, and knew how best to support people. They worked closely with other professionals and sought their advice to make sure people’s needs were met. Staff provided compassionate care to people reaching the end of their life.

The registered manager and provider completed audits. We have made a recommendation about developing these to reflect changes and improvements identified as needed during this inspection.

The registered manager was approachable, supportive and responsive to feedback.

People routinely made choices about all aspects of their care. They felt able to speak with staff or the registered manager if they were unhappy about anything or wanted to complain. The registered manager listened and learned from people’s feedback and was committed to providing person-centred and high-quality care.

More information is in the Detailed Findings section below. For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection: At the last inspection service was rated Good (report published 21 July 2016).

Why we inspected: This was a planned inspection to check that this service remained Good.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Ravensworth Lodge is a care home that provides accommodation and personal care for up to 24 older people who do not require nursing. There were 23 people living at the service on the day of our inspection. It is a converted house over four floors with a passenger lift. It is located in a quiet area of Scarborough within a short, level, walking distance of the local amenities.

There was a registered manager employed at this 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.

Staff were recruited safely with appropriate checks carried out of their background. There was sufficient staff on duty to meet people’s needs. They had been trained in safeguarding adults and could tell us how they would recognise and report any abuse.

There were health and safety safeguards in place ensuring that people lived in a safe, clean and hygienic environment. These were supported by clear policies and procedures. Risks to people’s health were identified and there were management plans in place to guide staff. Any accidents and incidents were recorded and analysed to identify any trends.

Medicines were managed safely by staff who had been trained.

Staff were skilled and knowledgeable about the people they provided care for. They received an induction when they started work at the service and were supported by senior staff through supervision and an annual appraisal.

Staff were trained in and worked within the principles of the Mental Capacity Act (MCA) 2005.

People’s nutritional needs were recorded in their care plans. Where people developed any problems around eating and drinking support was sought from allied healthcare professionals.

The environment was appropriate for the needs of people who lived at this service. There was ramped access to the house and a passenger lift to each floor.

Staff were caring and friendly towards people. They supported people’s dignity when caring for them. When people required palliative or end of life care staff had completed training and worked with clinical nurse specialists to ensure best practice.

Care plans and risk assessments were in place and these were reviewed regularly. They reflected the needs of people but would be enhanced if they were more detailed. This work was on-going.

Activities were organised at the service. The service employed an activities co-ordinator and people’s key workers supported people to go shopping or on outings.

There was a complaints procedure and people knew how to make a complaint. There had been no complaints during the last year. The registered manager explained that any minor issues were dealt with immediately.

People told us they had confidence in the registered manager. Feedback collected through surveys was positive about the service provided. People’s views were also sought at residents meetings, staff meetings and through daily conversations. There was an effective quality assurance system in place with audits carried out to identify any areas where the service could improve. Policies and procedures supported the management of the service providing guidance to staff.

They praised care staff and management and said they were provided with a reliable service and continuity of care. Their comments included, 'They know me very well,' and 'My family know I am being well looked after.' One person said 'I used to visit here so when the time came I knew it was the right place for me.'

People described all the staff as 'friendly' and 'helpful' and the activity organiser was singled out by several people for special mention. Comments included 'Nothing is too much bother' and 'She's grand, she will do anything for you.'

Overall, we found effective management systems were in place to promote people's safety and welfare.