All inspections: Ravenscroft - Care Quality Commission

At the comprehensive inspection at this service in September 2015 we identified eleven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued the provider with two warning notices nine requirements stating that they must take action to address these breaches. We shared our concerns with the local authority safeguarding and commissioning teams.

This focused inspection was carried out to assess whether the provider had taken the necessary actions to meet the two warning notices we had issued. We will carry out a further unannounced comprehensive inspection to assess whether the actions taken in relation to the warning notices have been sustained, to assess whether action has been taken in relation to the nine requirement notices and to provide an overall quality rating for the service.

This report only covers our findings in relation to the warning notices we issued and we have not changed the ratings since the inspection in September 2015. The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. You can read the report from our last comprehensive inspection by selecting 'all reports' links for Ravenscroft on our website at www.cqc.org.uk.

At this inspection we found the provider had taken action to address the issues highlighted in the warning notices. The home manager had developed a comprehensive action plan to address the warning notices and other requirements in the inspection report where they were found to be in breach of regulations. The plan was being updated to reflect the progress being made with improving the service. Meetings had been held with people using the service, their relatives and staff. The meetings were used to explain the actions they were taking, the improvements they wanted achieve and to seek feedback.

As the home is currently not fully occupied those rooms that required attention had been decommissioned pending a programme of refurbishment. People and their relatives had been consulted with and had been moved to other rooms within the home.

At our last inspection we found that not all people using the service had their own slings with which they could hoisted. We also found there was no information to indicate if or when slings had been cleaned. This meant people were at risk of cross contamination because the slings were shared and no cleaning schedule was in place. At this inspection people had all been allocated their own slings. Their were schedules in place which identified which slings were to be cleaned on each day.

Schedules were also in place to ensure that equipment was cleaned each week, which included hoists and wheelchairs. There were also resources made available to ensure that hoists were cleaned in-between each use.

New cleaning schedules were in place and the home had recruited additional housekeeping staff.

Some chairs and flooring had been replaced and the home had a programme of refurbishment in place. The landlord had dedicated money to support bringing the home up to standard. Quotes for work still outstanding were being sought.

Ravenscroft provides accommodation which includes nursing and personal care for up to 46 older people. At the time of our visit 20 people were using the service. The bedrooms are arranged over three floors. There are communal lounges and a dining area on the ground floor with a central kitchen and laundry. Ravenscroft is managed by Adiemus Care Limited which is part of a larger national organisation, Orchard Care Homes.

Whilst there was a registered manager employed by the service, they were currently on long term leave. The home was being overseen by an interim manager and the clinical nursing lead. 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 not always protected by the prevention and control of infection. Whilst there were systems in place to reduce the risk and spread of infection staff working in the service did not consistently comply with infection control practices.

Medicines were not always managed safely or stored safely. Medicines were not always available to people.

People receiving a service were not always protected by safe recruitment and selection processes. Information relating to past employment and behaviours were not always recorded in people’s personnel files.

Regular meetings were not held between staff and their line manager to discuss progress in the work of staff members; training and development opportunities and other matters relating to the provision of care for people living in the home.

People were not always supported to have sufficient to eat and drink. Records did not clearly identify if people were being supported to receive sufficient to eat and drink.

We found the service was not meeting the requirements of the Mental Capacity Act (2005), including Deprivation of Liberty Safeguards. Where people were deemed as lacking capacity assessments did not evidence how this staff came to this conclusion.

Staff had received training on how to protect people from abuse and were knowledgeable in recognising signs of potential abuse.

There was evidence of regular consultations with health care professionals where needed and people’s healthcare needs were regularly monitored.

People and their relatives spoke positively about the care and support they or their relative received.

We found staff were knowledgeable about people’s individual care and support needs. They were able to describe people as individuals. Staff knew about people’s likes, dislikes and preferences

Staff were motivated and caring. Staff were positive about the support the received from the interim manager.

We found 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.

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.

We considered all the evidence we had gathered under the outcomes we inspected. The inspection was undertaken by one inspector over two days: 28/05/14 and 29/05/14. During the inspection, we spoke with seven people living in the home and observed care for people in the communal areas of the home. We spoke with six members of staff and the registered manager.

We used the information to answer the five questions we always ask.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found -

Is the service safe?

People were treated with respect and dignity by staff. People told us that staff treated them well. People were cared for by staff who were aware of the risks to their safety and health and staff knew how to support them in a safe way.

People's safety was protected and promoted because the service obtained advice and support from other health and social care services that people required in order to meet their needs effectively.

Some improvements had been made in the maintenance of the home to help ensure people were protected against the risks of unsafe or unsuitable premises. Further work was being undertaken to make improvements to the environment.

We saw cleanliness varied across the home. People's bedrooms were clean and tidy. Seating and carpeting in some communal areas were stained. The laundry area had leaking pipes, was dusty and had walls that needed to be repaired The registered manager had increased hours for cleaning and domestic staff were seen to be doing their best. Plans were in place for new flooring in some areas so that floors could be cleaned more effectively

We have asked the provider what they are going to do to meet the requirements of the law in relation to protecting people from the risk of infection.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

CQC is the independent regulator of all health and social care in England. We are given powers by the government to register, monitor and inspect all health and care services. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Although no applications had needed to be submitted relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were kept safe from harm.

Is the service effective?

People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people's needs. This ensured their needs were clearly identified and action taken to improve their care.

People told us that they were happy with the care they received and their care needs were met by staff who were 'always very helpful ". We were told 'I don't have anything to complain about'. A family member spoken with told us 'on the whole very satisfied with the care and support'. They confirmed they were fully involved in their relatives care. It was clear from observations and from speaking with staff that they had a good understanding of people's care and treatment.

Is the service caring?

Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. Staff were knowledgeable about people's preferences and interests.

People told us "'staff are very good at doing the jobs I now can't do for myself', " 'staff are respectful, I can't grumble at all' and 'staff knock on the door and are respectful to me'. We saw people were receiving care in a sensitive way. We observed people being supported in making choices about their daily routines and the activities they would like to do.

Is the service responsive?

The service responded to people's changing needs through regular review of the care they received. Staff spoken with told us they had enough information about people's needs and demonstrated their knowledge about individual needs and preferences.

During our visit we found call bells sounded intermittently. We heard a call bell sounding from a person's room who was unwell, and saw that staff responded immediately.

People had access to activities that were meaningful and were supported to maintain relationships with their families.

Is the service well-led?

People were asked for their views about the service to help ensure their views contributed towards improvements and further development of the service.

The service had quality assurance systems in place so that shortfalls could be identified. The management of the home was monitored on a regular basis by the organisation. Planning was in place to make improvements.

The home had a registered manager. They told us they had made improvements to the home to ensure people lived in a safe environment. We saw the improvements made and that there were plans to for further maintenance.

We spoke with four people who used the service, four relatives, the manager and five members of staff. Three of the four people we spoke with told us they enjoyed living in the home and felt well cared for. One person said "it's very comfortable. They fall over backwards to help you." Another person told us "they couldn't do any more for me. They make me feel happy. Sometimes you have to be patient and wait your turn." One person was less than satisfied with the food and described their experience as 'so so'. Overall relatives feedback on the service supported people's views. One relative said "it's adequate, I have no complaints." Another told us "I'm satisfied with the care. I trust their judgement (about care issues)."

The provider had increased the number of staff hours dedicated to social activities and opportunities for social interaction. We saw there were plans to increase the range and amount of social activities available for people to participate in. There were records to demonstrate the amount and type of one to one contact people were receiving. This enabled staff to monitor whether people were receiving the support they needed.

We looked at five people's care records. The provider had recently changed and introduced new documentation. People's care records were in the process of being transferred to a new system and updated. The care records contained sufficient information for staff to provide safe, effective care.

This inspection was to follow up on concerns we identified in our previous inspection in relation to cleanliness and infection control and the staffing levels in the home. Whilst we were there we looked at other outcomes as part of our routine inspection work.

There were 36 people living in the home. We spoke with six support staff including the activities co-ordinator, housekeeping staff, four people who used the service and two relatives.

Overall people told us the care they received was good. One relative said 'the care is very good. They have a lot more interaction with her (person using the service).' Another person we spoke with said 'it's lovely. The care is really good.'

We observed people's permission was sought before support was provided.

We saw people who were able to get up and sit in the main communal living area were able to participate in a range of social activities if they wanted to. People who remained in their rooms or who were confined to bed had less contact with staff.

We were told new staff had been recruited. People said their needs were met in a timely manner.

We found the home was clean. Staff were knowledgeable about their role in preventing cross infection.

The provider had a system in place to monitor the quality of the service.

People's care plans were not updated regularly and did not reflect changes in other care records.

People and their relatives told us they were satisfied with the care and support they received. People said " every need is catered for." We were told "staff are respectful" We observed staff respected people's privacy and dignity.

Overall people told us the food was good. Special diets were catered for and people could always ask for an alternative to the menu and this would be accommodated. Staff monitored people's food and drink intake if they were assessed as at risk.

Overall the standard of cleanliness was satisfactory and staff followed infection control procedures. However the home had not appointed an infection control lead who would ensure standards were maintained and risks monitored.

People and their relatives told us they sometimes had to wait for long periods before call bells were answered. We saw from the staff rotas the provider's recommended staffing levels were regularly not being achieved.

The provider had an effective system to monitor the quality of the service.

People told us they were very happy with the care and treatment received.

Care plans were very detailed and described people's social history as well as medical and clinical needs.

We had received information about a safeguarding investigation into the care and treatment of pressure ulcers. This was still being investigated at the time of our visit. We visited because we wanted to know whether people living at the home had pressure damage to their skin. The Consultant Tissue Viability Nurse told us that none of the people examined had pressure damage.

We saw some staff engaging with people without explaining what they were going to do. The manager told us he would address the issue with the individual members of staff.

Other staff were very respectful and professional in their approach. We saw staff taking time to talk with people, particularly when supporting them to eat.

The new provider had appointed a regional training manager who was a registered nurse. They were reviewing members of staff's training needs to inform the training plan for the coming year, starting in April. The manager told us that both existing and new staff would be inducted into their role and the new policies and procedures.

The manager had identified areas for improvement during the four months he had worked there. He had started monthly audits of different aspects of the service and was taking action to improve things.

The manager told us that he planned to apply to become the registered manager.

Archived: Ravenscroft

All Inspections

24 November 2015

During an inspection looking at part of the service

10, 11, 14 September 2015

During an inspection of this service

10, 11 and 14 September 2015

During an inspection looking at part of the service

28, 29 May 2014

During a routine inspection

23 January 2014

During an inspection looking at part of the service

13 June 2013

During an inspection looking at part of the service

10 January 2013

During a routine inspection

22 March 2012

During an inspection in response to concerns