This inspection took place on 27 November and 4 December 2018 and was unannounced. Ryeview Manor Care Home is a care home service. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided. Both were looked at during this inspection.
Ryeview Manor Care Home provides care for up to 94 people, some of whom were living with dementia. At the time of the inspection, 91 people were living at 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.
Ryeview Manor Care Home is a three-storey building set in secure grounds in High Wycombe. The home comprised four units. Three for people living with dementia in need of residential care and one specialised residential unit for people with increasing needs, living with advancing dementia. Each unit had a sitting area and dining area. There was a secure garden with seating which was accessible to people living in the service.
The service was last inspected in August 2016 and was rated ‘Good’ in all key questions. At this inspection we found the service no longer met the criteria for Good in caring, responsive and well led and was rated ‘Requires improvement’.
Most staff interacted with people in a caring and sensitive way. We did however, observe that at times people were left seated in communal areas with little stimulation for periods of time.
Staff supported people to communicate their needs and protected their privacy, dignity and independence.
The registered manager used systems and processes to monitor quality and safety in the service, however, these were not always effective. Audits of medicines management contained insufficient detail to show all actions taken to mitigate risks and correct errors.
The provider had robust systems and processes in place to protect people from harm and abuse. Staff had completed safeguarding training and were knowledgeable about actions to take if they suspected abuse.
The registered manager deployed sufficient numbers of staff to meet people's needs and keep them safe. They used safe recruitment processes to ensure only staff who were suitable to work in a care setting were employed.
Safe systems were in place for the management of medicines and people were protected from the risk of acquiring an infection. Staff reflected on incidents to maintain people’s safety and prevent reoccurrences.
People received care from skilled, knowledgeable staff who had been appropriately trained. Staff were supported with regular supervision to help develop their knowledge.
Staff were aware of the legal protections in place to protect people who lacked mental capacity to make decisions about their care and support.
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 were supported to maintain a balanced diet. Risk assessments were in place for those at risk of malnutrition and dehydration. Staff supported people to access care from appropriate health care professionals.
Care plans contained details about the type of care and support people required. There was however, insufficient evidence to show these had been written in partnership with people and their families where appropriate. In addition, some language used by some staff to describe people and their behaviours was not person-centred.
Care plans showed that some details had been recorded regarding end of life care for people. There was however, a lack of sufficiently detailed evidence to show staff had explored and recorded people’s needs and preferences for the care they wished to receive in their last days.
There was a complaints policy in place and evidence showed complaints were investigated promptly and thoroughly.
The registered manager and staff were committed to delivering individualised care for people.
The registered manager used different methods to involve people, their families and staff in the service provided. Staff had linked with a local children’s nursery who visited the home regularly and staff held a monthly dementia café for people and their families.
The provider maintained a contemporaneous log of accidents and incidents and reflected on these, as well as on care provided as a means of making improvements and of preventing further incidents. The deputy manager was engaged in a safeguarding project and worked in partnership with people, relatives and social services to maintain people’s safety.
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of the report.