Archived: Ravensmere Rest Home

Updated 20 April 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors carried out this inspection.

Service and service type

Ravensmere Rest Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Ravensmere Rest Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 4 people and 1 relative, and we observed how people were being supported. We spoke with 3 members of staff including the provider who is also the registered manager. We reviewed a range of records. This included 8 people's care records and multiple medication records. We looked at 3 staff files in relation to safe recruitment and a variety of records relating to the management of the service, including safeguarding incident records.

Updated 20 April 2023

About the service

Ravensmere Rest Home is a residential care home providing personal care to 9 at the time of the

inspection. The service can support up to 24 people living with dementia, mental health conditions and learning disability.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support:

The provider failed to have safe and robust systems in place when incidents and accidents occurred, and these were not reported which placed people at serious risk of harm.

Risk management was poor. Staff were not provided with enough clear guidance to

support people safely.

There were limited opportunities for choice, control and independence. There was no activity schedule or plan and opportunities to access the community or to pursue individual interests or hobbies.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Where people lacked capacity to make decisions, the provider failed to put in place documents to support decision making.

Right Care:

Care was not always person-centred or designed to promote people's dignity, privacy and human rights.

Staff did not always understand how to protect people from poor care and abuse. The provider often delayed or cancelled visits from other agencies.

Not all staff were appropriately skilled to meet people’s needs and keep them safe.

Right Culture:

People were supported by staff who did not understand best practice in relation to people with a learning disability and/or autistic people.

There were indicators of a closed culture. Staff did not ensure risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity. The routines within the service were not always personalised to individual people.

The provider failed to develop effective governance and quality assurance system to assess the quality and safety of the support people received. The provider failed to acknowledge the concerns consistently identified during inspections which meant improvements were not made to improve the care people received.

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 inadequate (published 23 December 2021). At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended the provider reviews best practice guidance on creating a supportive environment for people living with dementia. At this inspection we found the provider had not acted on this recommendation or made any improvements.

Why we inspected

The inspection was prompted in part due to a safeguarding and continued concerns received about people living at Ravensmere Rest Home not having access to professionals and stakeholders involved in their care. The provider was continuing to not allow professionals and stakeholders to access the service to carry out their statutory obligations to ensure people’s safety and wellbeing. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, safeguarding, mental capacity, staff training and person-centred care.

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

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.