Ranvilles Nursing & Residential Care Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed 3 quality statements for this key question. The service accepted referrals for people who had very complex needs and people on a discharge to assess pathway (This is when people leave hospital, when safe to do so, and continue their care and assessment in a care home) even though they found it difficult to get support from partners for some of these people. The registered manager told us they were reviewing this and working with partners to address this issue. Risks associated with people’s health conditions and support needs were mostly well managed, but improvements were needed with records. There were a sufficient number of staff on duty and the recruitment of staff was safe. The provider had a range of training in place and most staff told us this was sufficient to equip them for their role. However, we were not assured that the mental health and dementia training was in depth enough and provided staff with sufficient knowledge considering the complex needs of the people they supported. The provider's representative took this seriously and told us they would review this. Relatives told us they thought people received safe care from staff at Ranvilles and risks were managed well.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives told us the admission process was positive and staff took the time to get to know people. For example, 1 relative said “Staff at the home met with me to talk about the details of my mum's needs, including her mental health condition and physical health needs. They took time to ask about her interests and skills to get a sense of the activities she may enjoy participating in.”

Staff described how they did their best to ensure people were supported to safely transition between services but working with partners sometimes had its challenges. For example, 1 staff member said, “The nurses or deputy manager will do a pre-admission assessment either face to face or over the phone. Sometimes the information we are handed over from the hospital is not correct. For example, we’ll be told that people are walking but they arrive and need to be hoisted.” Another member of staff said it was sometimes hard to get the right support for people who were on a ‘discharge to assess’ pathway. The registered manager told us they had a meeting with some partners with the aim of improved joint working and making transitions for people safer.

We received mixed feedback from partners about the way staff in the service worked with them to ensure safe systems, pathways and transitions. Partners told us they worked well with them to ensure continuity and good outcomes, but some were concerned that they accepted too many people into the service with complex needs. For example, 1 partner said, “Ranvilles are good at escalating back to ICB (Integrated Care Board) and other health professionals like GPs. Ranvilles continue to accept highly complex patients and the only alternative support they give is for ICB to fund 1:1 care provision, and often, this is almost not possible to remove or reduce. This appears to be financially driven rather than putting patients’ welfare first knowing that there is already a challenge for support from community mental health team.” The provider told us they did not agree with this and said they often declined admitting people as they felt they would not be able to meet their needs. Another partner provided positive feedback and stated, "Discharge summaries are reviewed carefully by staff when residents are admitted, staff often highlighting instruction for follow up documented."

The provider had policies in place in relation to referrals and admissions. Pre-assessments were carried out prior to people moving in and evidenced they could meet the needs of individuals. However, at the time of our site visits 10 people were receiving 1:1 care due to their complex needs and 15 ‘discharge to assess’ beds were being utilised. The registered manager told us how support from professionals external to the service could be lacking for these people. This put extra strain on staff in the home to ensure people’s needs were met. The registered manager told us they would be reviewing their processes in relation to referrals and admissions. When people were discharged or went to hospital, there were robust processes in place to ensure sufficient information was handed over to support good, joined up care.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives told us risks associated with people’s health conditions or support needs were well managed. For example, 1 said their relatives wounds had healed, and they had put on weight since admission. Another said, “Mum's room and equipment has been regularly reviewed and adapted to mitigate falls. Examples include consideration of mum's foot dressings, foot coverings, frame, seat position and furniture arrangements.”

Staff were mostly knowledgeable about how to support people with risks and knew what measures were in place to reduce them. For example, staff understood which people required a modified diet to reduce the risk of them choking and what topical creams people needed to reduce the risk of skin problems.

We observed people were supported in line with their risk assessments, for example, with the right consistency of food.

Records about people’s risks needed improvement. For example, skin integrity risk assessments were in place which outlined support needed for risks to people’s skin integrity to be reduced. However, records did not demonstrate these were being followed. For example, topical cream charts, robust mattress checks and repositioning charts were not always completed. The deputy manager had put measures in place to improve these records by the second day of our site visit. Risk assessments were variable in quality. Some were detailed and personalised whilst others required further input. For example, although some people’s records stated they were at risk of developing contractures, there was limited guidance for staff about how to monitor and reduce this risk. The registered manager had plans in place to ensure all risk assessments were detailed and personalised. Care plans were mostly reflective of people’s current needs, but we noted instances where this was not the case. For example, the guidance for staff about 1 person’s blood sugars and another’s repositioning. This did not impact on people because their condition had improved but inaccurate records can put people at risk of not having their needs met safely. We discussed this with the registered manager who told us of their plans to make improvements in this area.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Most relatives thought there were enough staff and staff were well trained. Comments included, “As regards with all of the staff who work there, all I ever see are staff who are fully competent and even when agency are used, they look like they have been well briefed.” and “I have always been very impressed by their [staff] work with residents, particularly those with complex mental health needs.”

Staff provided us with mixed feedback about staffing levels. Comments included, “I don’t have any concerns with staffing levels, it’s a highly skilled team here. We always have enough staff on.”, “Time is a barrier, I would say it’s the biggest factor. In my opinion, I would say there needs to be more care staff around peak times such as lunchtime or the evenings, these are very busy periods” and “Sometimes we are rushing.” Most staff were positive about the induction and training they had received to equip them for their roles. For example, a staff member said, “I’ve done training on lots of different areas for example, behaviour, diabetes, falls, fire awareness and hygiene. We do a lot of E-Learning, so this keeps me up to date with everything. There’s nothing I would like additional training on at the moment.” 2 staff members told us some staff members needed support to improve their communication skills. For example, 1 staff member said, 90 percent of issues with people are down to poor communication. The team would be stronger and more efficient if this improved. Some staff find it hard to pick up on softer signs of distress and then things can escalate, [other staff] have to keep sorting it out.” The registered manager and provider's representative told us during the inspection, they had booked training to develop staff in these areas.

Some people experienced distress and agitation associated with their dementia or mental health needs. 10 people required 1:1 care to keep them safe and were highly dependent on staff knowledge and skill to support their well-being. We observed a lack of meaningful engagement for some of these people which increased the risk of heightened distress. At other times, staff engaged well with people which improved their well-being. When we observed the mealtime experience, we found this could have been improved by more engagement and better organisation amongst staff for some people. We discussed this with the registered manager and provider's representative who told us an external consultant had already identified this and they had booked training for staff.

The provider used a tool based on people’s dependencies to ensure appropriate staffing numbers to meet people’s needs. Ranvilles specialises in supporting people with dementia and a mental health need and the registered manager told us they often accepted people that other services could not manage due to the complexity of their needs. A training programme was in place and nurses were supported to maintain their clinical skills. However, we were not assured training was in depth enough and provided staff with the necessary skills to support people with their dementia and mental health needs. Staff were provided with approximately 1 hour of dementia training, 35 minutes of mental health training per year and had recently had training about behaviours that challenge. We identified that bespoke training would have benefitted some staff and people. The provider had plans in place to deliver this. Safe recruitment practices were followed before new staff were employed to work with people. The relevant checks were made to ensure staff were of good character and suitable for their role.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.